Clinical Treatment (clinical + treatment)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report

DENTAL TRAUMATOLOGY, Issue 3 2007
Heng-Xing Cai
Abstract , Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed. [source]


Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update

DERMATOLOGIC SURGERY, Issue 4 2009
MOHAMED L. ELSAIE MD
BACKGROUND Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. OBJECTIVE To identify the current treatment modalities and their effectiveness in the treatment of stretch marks. MATERIALS AND METHODS Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications. RESULTS No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging. CONCLUSION The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies. [source]


Temporary self-expanding metallic stents and pneumatic dilation for the treatment of achalasia: a prospective study with a long-term follow-up

DISEASES OF THE ESOPHAGUS, Issue 5 2010
Y.-D. Li
SUMMARY The present study compares the efficacy of a self-expanding metallic stent (SEMS, diameter of 30 mm) and pneumatic dilation for the long-term clinical treatment of achalasia. A total of 155 patients diagnosed with achalasia were allocated for pneumatic dilation (n= 80, group A) or a temporary, 30-mm diameter SEMS (n= 75, group B). The SEMSs were placed under fluoroscopic guidance and removed by gastroscopy 4,5 days after placement. Data on clinical symptoms, complications, and long-term clinical outcomes were collected, and follow-up observations were performed at 6 months and at 1, 3,5, 5,8, 8,10, and >10 years, postoperatively. Pneumatic dilation and stent placement were technically successful in all of the patients. There were no significant differences in technique success, 30-day mortality, or complications between the two groups. The clinical remission rate in group A was significantly lower than that in group B at 1, 1,3, 3,5, 5,8 and, >10 years (P < 0.05), while the cumulative clinical failure rate in group A (66%, 53/80) was higher than that in group B (92%, 6/75). The mean primary patency in group B was significantly longer than that in group A (4.2 vs 2.1 years, respectively; P < 0.001). A temporary, 30-mm diameter SEMS was associated with a better long-term clinical efficacy in the treatment of patients with achalasia as compared with treatment with pneumatic dilation. [source]


Turner syndrome and the evolution of human sexual dimorphism

EVOLUTIONARY APPLICATIONS (ELECTRONIC), Issue 3 2008
Bernard Crespi
Abstract Turner syndrome is caused by loss of all or part of an X chromosome in females. A series of recent studies has characterized phenotypic differences between Turner females retaining the intact maternally inherited versus paternally inherited X chromosome, which have been interpreted as evidence for effects of X-linked imprinted genes. In this study I demonstrate that the differences between Turner females with a maternal X and a paternal X broadly parallel the differences between males and normal females for a large suite of traits, including lipid profile and visceral fat, response to growth hormone, sensorineural hearing loss, congenital heart and kidney malformations, neuroanatomy (sizes of the cerebellum, hippocampus, caudate nuclei and superior temporal gyrus), and aspects of cognition. This pattern indicates that diverse aspects of human sex differences are mediated in part by X-linked genes, via genomic imprinting of such genes, higher rates of mosaicism in Turner females with an intact X chromosome of paternal origin, karyotypic differences between Turner females with a maternal versus paternal X chromosome, or some combination of these phenomena. Determining the relative contributions of genomic imprinting, karyotype and mosaicism to variation in Turner syndrome phenotypes has important implications for both clinical treatment of individuals with this syndrome, and hypotheses for the evolution and development of human sexual dimorphism. [source]


Influenza-associated hospitalization in urban Thai children

INFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 5-6 2007
Piyarat Suntarattiwong
Background, Studies in North America and Europe have shown that young children are at increased risk of serious complications and hospitalization from influenza infection. In Thailand, however, influenza is commonly considered a mild infection that rarely requires hospitalization. An improved understanding of the burden of serious complications from influenza infection in young children is needed to inform clinical treatment and vaccination guidelines. Methods, We conducted a prospective study of children 0,5 years of age with lower respiratory tract infection or influenza-like illness admitted to a pediatric tertiary-care hospital in Bangkok, Thailand during July 2004 to July 2005. All respiratory specimens were tested for influenza using a rapid antigen test and tissue cell culture. Results, Thirty-nine of 456 (8.6%) hospitalized children had culture-positive influenza. Eighty percent of hospitalized influenza patients had no underlying chronic illnesses. Nineteen (49%) influenza patients required hospital stays of 5 days or more and two patients required mechanical ventilation. Influenza activity demonstrated bimodal seasonal variation with peak activity from August to October and January to April. Cough was present in 38 (97%) cases and fever >38.5°C was significantly associated with influenza. Conclusion, Influenza is an important cause of hospitalization in children <5 years of age in Thailand. Children <5 years should be considered as a target group when establishing clinical guidelines for antiviral treatment and influenza vaccination. [source]


Increased plasma MMP9 in integrin ,1-null mice enhances lung metastasis of colon carcinoma cells

INTERNATIONAL JOURNAL OF CANCER, Issue 1 2005
Xiwu Chen
Abstract Inhibitors of matrix metalloproteinases (MMPs) were developed as anticancer agents based on the observation that MMPs facilitate local tumor spread and metastasis by promoting matrix degradation and cell migration. Unfortunately, these inhibitors were unsuccessful in the clinical treatment of several cancers, including lung cancer. A possible reason contributing to their failure is that MMP activity is critical for the generation of inhibitors of tumor angiogenesis, including angiostatin. Thus, MMPs might play opposing roles in tumor vascularization and invasion. To determine which effect of elevated MMP levels dominates in the progression of metastatic cancer, experimental lung metastasis assays were performed in integrin ,1-null mice, a genetic model for increased plasma levels of MMP9 and MMP9-generated angiostatin (Pozzi et al., Proc. Natl. Acad. Sci. USA 2000;97:2202,7). We show that while the number of lung colonies in integrin ,1-null mice was significantly increased compared to their wild-type counterparts, tumor volume was markedly reduced. In vivo treatment with the MMP inhibitor doxycycline resulted in a significant decrease in the number of lung colonies in both genotypes, but the tumors that formed were bigger and more vascularized. Increased tumor vascularization paralleled decreased plasma levels of MMP9 and consequent decreased angiostatin synthesis. These results demonstrate that while inhibition of MMPs prevents and/or reduces tumor invasion and lung metastasis, it has the paradoxical effect of increasing the size and vascularization of metastatic tumors due to decreased generation of inhibitors of endothelial cell proliferation. The continued growth of these large well-vascularized tumors may explain the poor efficacy of MMP inhibitors in lung cancer clinical trials. © 2005 Wiley-Liss, Inc. [source]


High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2009
A. P. M. S. Romão
Summary Background:, Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with consequent difficulty in diagnosis and treatment. Patients with CPP have high levels of anxiety and depression, with a consequent impairment of their quality of life. Aims:, The objective of this study was to determine the prevalence of anxiety and depression and their impact on the quality of life of women with CPP. Materials and methods:, A cross-sectional controlled study was conducted on 52 patients with CPP and 54 women without pain. Depression and anxiety were evaluated by the Hospital Anxiety and Depression Scale, and quality of life was evaluated by the World Health Organization Quality of life Whoqol-bref questionnaire. Data were analysed statistically by the Mann-Whitney U -test, the Fisher exact test, chi-square test and Spearman correlation test. Results:, The prevalence of anxiety was 73% and 37% in the CPP and control groups, respectively, and the prevalence of depression was 40% and 30% respectively. Significant differences between groups were observed in the physical, psychological and social domains. Patients with higher anxiety and depression scores present lower quality of life scores. Discussion:, The fact that DPC is a syndromic complex, many patients enter a chronic cycle of search for improvement of medical symptoms. The constant presence of pain may be responsible for affective changes in dynamics, family, social and sexual. Initially the person is facing the loss of a healthy body and active, to a state of dependence and limitations. In this study, patients with higher scores of anxiety and depression scores had lower quality of life and patients with lower scores of anxiety and depression had scores of quality of life. These results show that perhaps the depression and anxiety may be related to the negative impact on quality of life of these patients. Conclusion:, In view of this association, we emphasise the importance of a specific approach to the treatment of anxiety and depression together with clinical treatment to improve the quality of life of these patients. [source]


Evaluation of Interventions Proposed for Altered Tissue Perfusion: Cardiopulmonary in Patients Hospitalized With Acute Myocardial Infarction

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003
Ivanise Maria Gomes
PURPOSE To evaluate the effectiveness and efficacy of the interventions proposed for patients with altered tissue perfusion: cardiopulmonary, according to NIC and NOC taxonomies. METHODS Prospective and descriptive study carried out in the cardiology unit of a school hospital with patients under clinical treatment followed from admission until discharge. Patient data were collected using the unit's assessment tool and nursing diagnoses were established. Daily activities were proposed for these patients based on NIC interventions "cardiac care: acute,""cardiac care," and "cardiac care: rehabilitative." Results were evaluated according to indicators selected from NOC's Tissue Perfusion: Cardiac. FINDINGS The sample comprised 25 patients (12 males, 13 females), age range 39 to 83 years. Days hospitalized averaged 3.5 in the coronary unit and 3.5 in the cardiology infirmary, for a total of 7 hospital days. The nursing diagnosis was made based on defining characteristics: enzymatic and ECG changes were found in 100% of the patients, chest pain (96%), diaphoresis (80%), and nausea (72%). The related factor in evidence for 100% of the sample was coronary arterial flow interruption. Patients were evaluated according to NOC outcomes both before starting activities and daily, with the following results: chest pain , 64% of patients initially presented pain with score 1, most (72%) presented scores 4 and 5 on day 2; on days 3, 5, 6, and 7 of hospitalization, all patients reported absence of pain (score 5). On day 4 only, 4% of patients reported pain with intensity 7 (score 2). Profuse diaphoresis was found in 80% of the sample on day 1 of hospitalization, and that disappeared in the course of the remaining days. Nausea was found in 44% of the population with score 1 on day 1 of hospitalization, and disappeared subsequently. Most the patients (84%) did not present with vomiting. Also, no evidence was found of vital sign changes in most of the sample. ECG presented score 1 in 72% of the sample on day 1, greatly decreasing from day 2. Cardiac enzymes appeared in 100% of the sample, decreasing in subsequent days. Heart ejection fraction, pulmonary artery pressure, heart rate, and myocardial scanning indicators were not measured. CONCLUSIONS Indicators evaluated achieved score 5 (no compromise) on hospital discharge in 100% of patients, which evidences effectiveness of the interventions performed. [source]


Understanding cisplatin resistance using cellular models

IUBMB LIFE, Issue 11 2007
Britta Stordal
Abstract Many mechanisms of cisplatin resistance have been proposed from studies of cellular models of resistance including changes in cellular drug accumulation, detoxification of the drug, inhibition of apoptosis and repair of the DNA adducts. A series of resistant models were developed from CCRF-CEM leukaemia cells with increasing doses of cisplatin from 100 ng/ml. This produced increasing resistance up to 7-fold with a treatment dose of 1.6 ,g/ml. Cisplatin resistance in these cells correlated with increases in the antioxidant glutathione, yet treatment with buthionine sulphoximine, an inhibitor of glutathione synthesis, had no effect on resistance, suggesting that the increase in glutathione was not directly involved in cisplatin resistance. Two models were developed from H69 SCLC cells, H69-CP and H69CIS200 using 100 ng/ml or 200 ng/ml cisplatin respectively. Both cell models were 2-4 fold resistant to cisplatin, and have decreased expression of p21 which may increase the cell's ability to progress through the cell cycle in the presence of DNA damage. Both the H69-CP and H69CIS200 cells showed no decrease in cellular cisplatin accumulation. However, the H69-CP cells have increased levels of cellular glutathione and are cross resistant to radiation whereas the H69CIS200 cells have neither of these changes. This suggests that increases in glutathione may contribute to cross-resistance to other drugs and radiation, but not directly to cisplatin resistance. There are multiple resistance mechanisms induced by cisplatin treatment, even in the same cell type. How then should cisplatin-resistant cancers be treated? Cisplatin-resistant cell lines are often more sensitive to another chemotherapeutic drug paclitaxel (H69CIS200), or are able to be sensitized to cisplatin with paclitaxel pre-treatment (H69-CP). The understanding of this sensitization by paclitaxel using cell models of cisplatin resistance will lead to improvements in the clinical treatment of cisplatin resistant tumours. IUBMB Life, 59: 696-699, 2007 [source]


The Effect of Insomnia Definitions, Terminology, and Classifications on Clinical Practice

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S7 2005
Andrew D. Krystal MD
There is a need for newer, more clinically useful classifications for insomnia. Identification of specific subtypes of insomnia helps anchor research, allows for prediction of prognosis/course of the condition, and may allow for individualization of treatment. Existing classifications differ, and many terms remain inadequately defined, which leads to diagnostic confusion. Historically, insomnia has been classified according to symptom type, symptom duration, and underlying cause, but these classifications have not been based on evidence of their utility, and newer research suggests the need for change. Symptoms may include difficulty falling asleep, trouble staying asleep, and not feeling restored by sleep, although it has not been clear that it is possible to identify distinct subtypes of patients by symptom or that distinguishing symptom type affects the course of clinical treatment. Classification of insomnia by duration most commonly involves three categories: transient (no more than a few days), short-term (up to 3 weeks), and long-term (more than 3 weeks). This categorization is of uncertain utility and has been primarily based on nonempiric concerns about treatment with sedative-hypnotic medications for periods longer than several weeks. The subtyping of insomnia in terms of whether there is an identifiable underlying cause such as a psychiatric or medical illness was based on an unproven assumption that in most instances other disorders caused insomnia. Recent studies suggest the need to revisit these classification strategies. Evidence that symptom types typically overlap and change over time complicates the categorization of subjects by whether they have difficulty falling asleep or staying asleep or have nonrestorative sleep. New studies of the treatment of chronic insomnia change the perspective on duration of treatment and, as a result, classification of duration of disease. Two studies of nightly pharmacotherapy for insomnia including more than 800 insomnia patients have not identified any increase in the risks after 3 to 4 weeks of treatment. In addition, nonpharmacological treatments demonstrate long-lasting efficacy in patients with chronic insomnia, and the development of abbreviated cognitive-behavioral therapies, which are particularly well suited to primary care practice, have improved their applicability. Newer studies of the relationships between insomnia and associated medical and psychiatric conditions undermine the notion that insomnia is always a symptom and caused by an underlying condition. They suggest that, although it is important to identify and treat these conditions, this may not be sufficient to alleviate the insomnia, which may adversely affect the course of the associated disorder. As a result, treatment targeted specifically to the insomnia should be considered. All of these developments point to an increasing ability to tailor therapy to the particular needs of patients and to optimize the clinical management of insomnia. [source]


Strong Static Magnetic Field Stimulates Bone Formation to a Definite Orientation In Vitro and In Vivo,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2002
Hiroko Kotani Ph.D.
Abstract The induction of bone formation to an intentional orientation is a potentially viable clinical treatment for bone disorders. Among the many chemical and physical factors, a static magnetic field (SMF) of tesla order can regulate the shapes of blood cells and matrix fibers. This study investigated the effects of a strong SMF (8 T) on bone formation in both in vivo and in vitro systems. After 60 h of exposure to the SMF, cultured mouse osteoblastic MC3T3-E1 cells were transformed to rodlike shapes and were orientated in the direction parallel to the magnetic field. Although this strong SMF exposure did not affect cell proliferation, it up-regulated cell differentiation and matrix synthesis as determined by ALP and alizarin red stainings, respectively. The SMF also stimulated ectopic bone formation in and around subcutaneously implanted bone morphogenetic protein (BMP) 2-containing pellets in mice, in which the orientation of bone formation was parallel to the magnetic field. It is concluded that a strong SMF has the potency not only to stimulate bone formation, but also to regulate its orientation in both in vitro and in vivo models. This is the first study to show the regulation of the orientation of adherent cells by a magnetic field. We propose that the combination of a strong SMF and a potent osteogenic agent such as BMP possibly may lead to an effective treatment of bone fractures and defects. [source]


Attention Deficit Hyperactivity Disorder: Current Concepts and Underlying Mechanisms

JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 3 2000
Brenda J. Wagner PhD
TOPIC. Neuropsychological concentration of attention deficit hyperactivity disorder (ADHD). PURPOSE. Survey of current understanding of underlying neural systems and pathways involved in ADHD and the relationship to specific behavioral patterns. SOURCES. Literature review, author's experience in neuropsychological assessment and clinical treatment. CONCLUSIONS. Clinicians will be able to specify treat men t interventions designed to compensate for specific behavioral patterns and functional deficits. [source]


A psychometric evaluation of the Chinese version of the stage of change-readiness and treatment-eagerness scale

JOURNAL OF CLINICAL NURSING, Issue 17 2009
Mei-Yu Yeh
Aims., The present study analysed the psychometric properties of a Chinese version of the stage of change-readiness and treatment-eagerness scale among alcohol-dependent patients and investigated whether a three-factor structure fit the data. Background., The stage of change-readiness and treatment-eagerness scale is a 19-item instrument designed to measure alcohol-dependent patients' motivation for change. However, this instrument had not been translated and validated for use in Taiwan. Design., Survey. Methods., A sample of 161 alcohol-dependent patients receiving alcohol-related treatment in psychiatric hospital outpatient and inpatient units was included. Confirmatory factor analyses were conducted on three-factor measurement models of the stage of change-readiness and treatment-eagerness scale. Results., Confirmatory factor analyses supported the presence of a three-factor modified model (ambivalence, recognition and taking steps) among alcohol-dependent patients. Higher internal item consistency was found for the recognition and taking step factors, while the ambivalence factor was shown to have lower internal consistency. Convergent, discriminant and concurrent validity were obtained for the assessment of severity of alcohol dependence. Conclusions., The results indicated that the 11-item, three-factor modified Chinese version of the stage of change readiness and treatment eagerness scale provided best goodness of fit for the data in this study. This study demonstrated that the Chinese version of the stage of change readiness and treatment eagerness scale is a reliable and valid self-report measure for the assessment of changing motivation in alcohol-dependent patients. Relevance to clinical practice., The Chinese version of stage of change readiness and treatment eagerness scale is applicable for use in clinical treatment and research, predicting motivation for change and evaluating intervention outcomes in Taiwan. [source]


Interpretation of teasing during early adolescence

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 1 2007
Allison Kanter Agliata
Research has suggested that teasing, especially about physical appearance, is a common experience with negative consequences for adolescents. This study aimed to examine the cognitive processes of adolescents exposed to teasing. Students from two middle schools were assigned randomly to view videotaped vignettes of appearance-related teasing, competency teasing, or a control situation and completed questionnaires to assess their cognitive reactions and memories of the teasing. Results indicated that adolescent girls recalled appearance-related teasing more readily than competency teasing, adolescent girls with high body dissatisfaction recalled fewer positive appearance words, and participants exposed to competency teasing were more likely to recall competency words. The findings indicated that cognitive processes may be important in the study of adolescents' interpretation of teasing and for clinical treatment of adolescents who are teased. © 2006 Wiley Periodicals, Inc. J Clin Psychol 63: 23,30, 2007. [source]


Cerebral Vasospasm in Childhood Migraine During the Intermigrainous Period

JOURNAL OF NEUROIMAGING, Issue 2 2004
Lauren E. Boasso
ABSTRACT Background and Purpose. The aims of this study were to evaluate the changes in intracranial hemodynamics and assess the presence of vasospasm in children with migraine during the intermigrainous period. Methods. Transcranial Doppler (TCD) sonography findings, clinical examinations, and the vasospastic index of Lindegaard were analyzed for children who fulfilled the criteria for childhood migraine. The significance of the presence of vasospasm and abnormal hemodynamics were statistically analyzed using the normal approximation to the binomial test method. TCD sonography was performed using the standard published techniques for children. Results. Sixty-two patients between the ages of 5 and 17 years who had undergone at least one TCD sonographic examination were selected for this study. A total of 113 TCD sonographic examinations were performed on the patients. Elevated mean blood flow velocities were found in 23 of 62 patients (37%) (P< .001). Early vasospasm was found in 4 of 62 patients (6.5%) (P< .001). Bruits were noted in 35 of 62 patients (56%). Conclusions. This study raises the possibility of cerebral vasospasm in the intermigrainous period in childhood migraine. Further studies are needed to elaborate on the pathophysiology of cerebrovascular behavior during this period. These findings may have a significant impact on the current clinical treatment of childhood migraine. [source]


Solution structure of nociceptin peptides

JOURNAL OF PEPTIDE SCIENCE, Issue 9 2002
Pietro Amodeo
Abstract Peptides embedded in the sequence of pre-pro-nociceptin, i.e. nociceptin, nocistatin and orphanin FQ2, have shed light on the complexity of the mechanisms involving the peptide hormones related to pain and have opened up new perspectives for the clinical treatment of pain. The design of new ligands with high selectivity and bioavailability, in particular for ORL1, is important both for the elucidation and control of the physiological role of the receptor and for their therapeutic importance. The failure to obtain agonists and antagonists when using, for nociceptin, the same substitutions that are successful for opioids, and the conformational flexibility of them all, justify systematic efforts to study the solution conformation under conditions as close as possible to their natural environment. Structural studies of linear peptides in solution are hampered by their high flexibility. A direct structural study of the complex between a peptide and its receptor would overcome this difficulty, but such a study is not easy since opioid receptors are membrane proteins. Thus, conformational studies of lead peptides in solution are still important for drug design. This review deals with conformational studies of natural pre-nociceptin peptides in several solvents that mimic in part the different environments in which the peptides exert their action. None of the structural investigations yielded a completely reliable bioactive conformation, but the global conformation of the peptides in biomimetic environments can shed light on their interaction with receptors. Copyright © 2002 European Peptide Society and John Wiley & Sons, Ltd. [source]


A Post-ischaemic Single Administration of Galanthamine, a Cholinesterase Inhibitor, Improves Learning Ability in Rats

JOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 9 2000
A. I. ILIEV
Transient forebrain ischaemia is widely observed in clinical practice. We have examined the effect of a single administration of the Cholinesterase inhibitor galanthamine (2 mgkg,1, i.p.) 25 min after reperfusion in male Sprague-Dawley rats (180 ± 20 g) after a 20-min common carotid artery occlusion. Twenty-four-hours post-ischaemia there was no difference in motor co-ordination or muscle tonus of the rats treated with or without galanthamine as assessed by the rota-rod test. Learning ability was examined using the shuttle-box test, evaluating the latency time and the number of errors for six days in succession. The performance of the ischaemic saline-injected rats was significantly impaired on days 4, 5, 6 (latency time) compared with the non-ischaemic rats and with the ischaemic animals administered galanthamine (P< 0.05). Similar results were obtained when counting the number of errors (failure to cross the cage during conditioned or unconditioned stimulus). The monitoring of body temperature during the first 12-h post-ischaemia did not show any significant difference between the groups. The data showed a beneficial effect of galanthamine on the recovery of learning ability when administered once only post-ischaemia. This suggests a direct effect on the early pathologic mechanisms of CNS damage. Cholinesterase inhibitors may prove useful in the early clinical treatment of ischaemic conditions. [source]


Critical management in patients with severe enterovirus 71 infection

PEDIATRICS INTERNATIONAL, Issue 3 2006
JIEH-NENG WANG
Abstract Objective: The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection. Methods: A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison. Results: The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2 ± 5.0 vs 4.9 ± 1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute-stage and long-term survival rates were higher in the study group (100% vs 43%, 87% vs 29%). Conclusion: Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management. [source]


Cyclooxygenase-2 Expression Induced by Photofrin Photodynamic Therapy Involves the p38 MAPK Pathway,

PHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 2 2008
Marian Luna
Photodynamic therapy (PDT), using the porphyrin photosensitizer Photofrin (PH), is approved for the clinical treatment of solid tumors. In addition to the direct cytotoxic responses of PH,PDT-mediated oxidative stress, this procedure also induces expression of angiogenic and prosurvival molecules including cyclooxygenase-2 (COX-2). In vivo treatment efficacy is improved when PH-PDT is combined with inhibitors of COX-2. In the current study we evaluated the signaling pathways involved with PH,PDT-mediated COX-2 expression in a mouse fibrosarcoma cell line. COX-2 promoter reporter constructs with mutated transcription elements documented that the nuclear factor kappa B (NF,B) element, cyclic-AMP response element 2 (CRE-2), CCAAT/enhancer binding protein (C/EBP) element and activator binding protein-1 (AP-1) element were responsive to PH-PDT. Transcription factor binding assays demonstrated that nuclear protein binding to NF,B, CRE-2, c-fos and c-jun elements were elevated following PH-PDT. Kinase phosphorylation upstream of COX-2 expression was also examined following PH-PDT. Stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) and c-Jun were phosphorylated following PH-PDT but the SAPK/JNK inhibitor SP600125 failed to attenuate COX-2 expression. In contrast, p38 mitogen-activated protein kinase (MAPK), which activates CRE-2 binding, was phosphorylated following PH-PDT and inhibitors of p38 MAPK, SB203580 and SB202190, decreased PH,PDT-induced COX-2 expression at both the mRNA and protein levels. Extracellular signal-regulated kinase (ERK1/2) phosphorylation, which also increases CRE-2 binding activity, was initially high in untreated cells, decreased immediately following PH-PDT and then rapidly increased. MEK1/2 is immediately upstream of ERK1/2 and the MEK1 inhibitor PD98059 failed to attenuate COX-2 expression while the MEK1/2 inhibitor U0126 induced a slight decrease in COX-2 expression. The NF,B inhibitor SN50 failed to reduce COX-2 expression. These results demonstrate that multiple protein kinase cascades can be activated by oxidative stress and that the p38 MAPK signaling pathway and CRE-2 binding are involved in COX-2 expression following PH-PDT. [source]


Identification of circulatory and excretory metabolites of meisoindigo in rat plasma, urine and feces by high-performance liquid chromatography coupled with positive electrospray ionization tandem mass spectrometry

RAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 6 2010
Meng Huang
Meisoindigo has been a routine therapeutic agent in the clinical treatment of chronic myelogenous leukemia in China since the 1980s. However, information relevant to in vivo metabolism of meisoindigo is absent so far. In this study, in vivo circulatory metabolites of meisoindigo in rat plasma, as well as excretory metabolites in rat urine and feces, were identified by liquid chromatography/tandem mass spectrometry (LC/MS/MS). Integration of multiple reaction monitoring with conventional metabolic profiling methodology was adopted to enable a more sensitive detection of in vivo metabolites. By comparing with the MS/MS spectra and retention times of the in vitro reduced metabolites, the major metabolites in rat plasma were proposed to form from 3,3, double bond reduction, whereas the minor metabolites were formed from reduction followed by N-demethylation, and reduction followed by phenyl mono-oxidation. The major metabolites in the rat urine were proposed to form from reduction followed by phenyl mono-oxidation, and its glucuronide conjugation and sulfate conjugation, whereas the minor metabolites were formed from 3,3, double bond reduction, N-demethylation, reduction followed by N-demethylation, phenyl di-oxidation, phenyl mono-oxidation and its glucuronide conjugation and sulfate conjugation. The major metabolites in the rat feces were proposed to form from reduction followed by phenyl mono-oxidation, whereas the minor metabolites were formed from reduction followed by N-demethylation, and reduction followed by phenyl di-oxidation. The phase I metabolic pathways showed a significant in vitro,in vivo correlation in rat. Copyright © 2010 John Wiley & Sons, Ltd. [source]


Acute Otitis Externa: Efficacy and Tolerability of N-Chlorotaurine, a Novel Endogenous Antiseptic Agent,

THE LARYNGOSCOPE, Issue 5 2004
Andreas Neher MD
Abstract Objective: The study's objective was to test the tolerability and efficacy of the endogenous antiseptic N-chlorotaurine (NCT) in comparison with a standard clinical treatment according to a phase IIb clinical trial protocol. Study Design: The antimicrobial agent NCT was compared with the antibiotic component drops Otosporin (containing neomycin, polymyxin B, and hydrocortisone) for topical treatment of acute otitis externa in a randomized and rater-blinded clinical study. Methods: Fifty patients suffering from acute otitis externa were divided into two groups according to a randomized list. The test group was treated with 1 mL of 1% aqueous NCT solution, the reference group with 1 mL of Otosporin. The substances were applied to the external ear canal at one daily session until the signs of infection disappeared. Efficacy and tolerability were evaluated daily by visual analogue scale and a six-step infection score. In addition, smears were analyzed to identify the causative pathogens. Results: Both medications were equally well tolerated by the patients. The treatment was successful for all patients of the NCT group, whereas in one patient from the reference group, the infection did not disappear. The inflammation score improved more rapidly in the NCT group, which resulted in an earlier termination of the therapy. This difference became highly significant on days 4 to 7 (P < .01 each). Time needed for disappearance of inflammation (score 0) was 5.6 ± 1.6 (mean ± SD, range 3,9) days in the NCT group and 7.4 ± 1.6 (range 4,10) days in the Otosporin group (P < .001). As expected, micro-biologic cultures from ear swabs revealed Pseudomonas aeruginosa (58%) followed by Staphylococcus aureus (18%) as the main causative pathogens. Conclusions: NCT appears to be well tolerated and more effective than the therapy using antibiotic component drops. Because of its endogenous nature and its higher efficacy, NCT appears to be a good choice for topical treatment of acute otitis externa. [source]


The Politics of Obesity: A Current Assessment and Look Ahead

THE MILBANK QUARTERLY, Issue 1 2009
ROGAN KERSH
Context: The continuing rise in obesity rates across the United States has proved impervious to clinical treatment or public health exhortation, necessitating policy responses. Nearly a decade's worth of political debates may be hardening into an obesity issue regime, comprising established sets of cognitive frames, stakeholders, and policy options. Methods: This article is a survey of reports on recently published studies. Findings: Much of the political discussion regarding obesity is centered on two "frames," personal-responsibility and environmental, yielding very different sets of policy responses. While policy efforts at the federal level have resulted in little action to date, state and/or local solutions such as calorie menu labeling and the expansion of regulations to reduce unhealthy foods at school may have more impact. Conclusions: Obesity politics is evolving toward a relatively stable state of equilibrium, which could make comprehensive reforms to limit rising obesity rates less feasible. Therefore, to achieve meaningful change, rapid-response research identifying a set of promising reforms, combined with concerted lobbying action, will be necessary. [source]


Intrusive trauma memory: A review and functional analysis

APPLIED COGNITIVE PSYCHOLOGY, Issue 8 2009
Julie Krans
Our contribution to this special issue focuses on the phenomenon of intrusive trauma memory. While intrusive trauma memories can undoubtedly cause impairment, we argue that they may exist for a potentially adaptive reason. Theory and experimental research on intrusion development are reviewed and possible functions of intrusive trauma memory are explored. These functions include aiding emotional processing, preventing future harm and protecting the coherence of the self. The issue of intrusive images in other disorders than posttraumatic stress disorder is briefly addressed. This review suggests that the study of function is important for a nuanced view on the modulation of intrusive trauma memory in both experimental psychopathology and clinical treatment. Copyright © 2009 John Wiley & Sons, Ltd. [source]


Efficacy of Bone Marrow Mononuclear Cells to Promote Bone Regeneration Compared With Isolated CD34+ Cells From the Same Volume of Aspirate

ARTIFICIAL ORGANS, Issue 7 2010
Shinji Yasuhara
Abstract Autologous bone marrow mononuclear cell (BMMNC) transplantation is currently an emerging clinical treatment in the orthopedic as well as cardiovascular fields. It is believed that the therapeutic effect of the BMMNCs is due to neovascularization enhanced by the CD34+ cells contained therein, which include endothelial progenitor cells. However, isolation of the CD34+ cell fraction for clinical application has many disadvantages such as cost and invasiveness related to cell mobilization with cytokine. To investigate whether a purification step is in fact necessary for bone regeneration, we separated BMMNCs, CD34+, and CD34 - cells from the same initial volume of rabbit bone marrow aspirates. We then transplanted them back into a femoral bone defect of the same rabbit together with atelocollagen gel and basic fibroblast growth factor (bFGF) and evaluated neovascularization and bone regeneration up to 8 weeks after transplantation. The greatest potential for neovascularization and bone regeneration medicated by cells from the same volume of bone marrow aspirate was found in the BMMNC group. Although purified CD34+ cells might be an ideal cell source, BMMNCs could be a practical and feasible cell source for bone regeneration in present clinical settings with limited cost, availability of materials, and technical issues for transplantation. [source]


Linking family dysfunction to suicidal ideation: Mediating roles of self-views and world-views

ASIAN JOURNAL OF SOCIAL PSYCHOLOGY, Issue 2 2009
Sylvia Xiaohua Chen
Research on suicide has documented various factors predicting suicidal ideation. The present study focused on the pathways emanating from one of the external, environmental forces (i.e. family dysfunction) through internal responses (beliefs about oneself and about the world), to suicidal ideation among Hong Kong Chinese. Using structural equation modelling, we tested the mediating roles of depressive self-views (including stress perception, depressive cognition and negative self-esteem) as well as two dimensions of social axioms (social cynicism and negative reward for application). Multi-group analysis showed that the mediation model was invariant across both males and females. Being socialized into a problematic family of origin affected multiple aspects of one's assessments of both oneself and one's world which, in turn, lead to greater suicidal ideation. Our findings provide important implications for assessing suicidal risk and guiding interventions in clinical treatment. [source]


Regulation of bladder muscarinic receptor subtypes by experimental pathologies

AUTONOMIC & AUTACOID PHARMACOLOGY, Issue 3 2006
M. R. Ruggieri Sr
Summary 1 The M3 muscarinic receptor subtype is widely accepted as the receptor on smooth muscle cells that mediates cholinergic contraction of the normal urinary bladder and other smooth muscle tissues, however, we have found that the M2 receptor participates in contraction under certain abnormal conditions. The aim of this study was to determine the effects of various experimental pathologies on the muscarinic receptor subtype mediating urinary bladder contraction. 2 Experimental pathologies resulting in bladder hypertrophy (denervation and outlet obstruction) result in an up-regulation of bladder M2 receptors and a change in the receptor subtype mediating contraction from M3 towards M2. Preventing the denervation-induced bladder hypertrophy by urinary diversion prevents this shift in contractile phenotype indicating that hypertrophy is responsible as opposed to denervation per se. 3 The hypertrophy-induced increase in M2 receptor density and contractile response is accompanied by an increase in the tissue concentrations of mRNA coding for the M2 receptor subtype, however, M3 receptor protein density does not correlate with changes in M3 receptor tissue mRNA concentrations across different experimental pathologies. 4 This shift in contractile phenotype from M3 towards M2 subtype is also observed in aged male Sprague,Dawley rats but not females or either sex of the Fisher344 strain of rats. 5 Four repeated, sequential agonist concentration response curves also cause this shift in contractile phenotype in normal rat bladder strips in vitro, as evidenced by a decrease in the affinity of the M3 selective antagonist p -fluoro-hexahydro-sila-diphenidol (p -F-HHSiD). 6 A similar decrease in the contractile affinity of M3 selective antagonists (darifenacin and p -F-HHSiD) is also observed in bladder specimens from patients with neurogenic bladder as well as certain organ transplant donors. 7 It is concluded that although the M3 receptor subtype predominately mediates contraction under normal circumstances, the M2 receptor subtype can take over a contractile role when the M3 subtype becomes inactivated by, for example, repeated agonist exposures or bladder hypertrophy. This finding has substantial implications for the clinical treatment of abnormal bladder contractions. [source]


Functional analysis and habit-reversal treatment of tics

BEHAVIORAL INTERVENTIONS, Issue 3 2005
James E. Carr
Although there is empirical support for a biological etiology of Tourette syndrome and other tic disorders, researchers have recently begun examining the role of reinforcement in tic maintenance. Using experimental functional analyses, researchers have identified both social and nonsocial functions for the tics of a variety of individuals. However, there are at least two problems with this developing literature. First, all but one of the studies employed a single participant and many of them were referred for clinical treatment. These factors leave open the possibility that the selection or referral process may have contributed to the reported outcomes. Second, five of the seven participants had a developmental disability or delay. Thus, the majority of participants in this literature are unrepresentative of most individuals with tic disorders. The purpose of the present study was to investigate the operant functions of the tics of multiple children who were recruited for the study. We evaluated the tics of three typically developing children using functional analysis. Results indicated nonsocial functions for all tics. Two of the participants were then treated using habit reversal; both of them experienced tic reductions. Copyright © 2005 John Wiley & Sons, Ltd. [source]


Genetic and environmental factors in the etiology of esophageal atresia and/or tracheoesophageal fistula: An overview of the current concepts

BIRTH DEFECTS RESEARCH, Issue 9 2009
Janine F. Felix
Abstract Esophageal atresia and/or tracheoesophageal fistula (EA/TEF) are severe congenital anomalies. Although recent years have brought significant improvement in clinical treatment, our understanding of the etiology of these defects is lagging. Many genes and genetic pathways have been implicated in the development of EA/TEF, but only a few genes have been shown to be involved in humans, in animals, or in both. Extrapolating data from animal models to humans is not always straightforward. Environmental factors may also carry a risk, but the mechanisms are yet to be elucidated. This review gives an overview of the current state of knowledge about both genetic and environmental risk factors in the etiology of EA/TEF. Birth Defects Research (Part A) 2009. © 2009 Wiley-Liss, Inc. [source]


Chemosensitization of human prostate cancer using antisense agents targeting the type 1 insulin-like growth factor receptor

BJU INTERNATIONAL, Issue 3 2003
G.O. Hellawell
OBJECTIVE To assess the effect of the downregulation of type 1 insulin-like growth factor receptor (IGF1R) on the chemosensitivity of prostate cancer cells. IGF1R is overexpressed by prostate cancer compared with benign prostatic epithelium and IGF1R expression commonly persists in androgen-independent metastatic disease at levels comparable to those in the primary. MATERIALS AND METHODS Human androgen-independent DU145 prostate cancer cells were transfected with IGF1R antisense oligonucleotides or antisense RNA. Transfected cultures were treated with cisplatin, mitoxantrone, paclitaxel or vehicle control, and survival measured using a clonogenic assay. RESULTS Both antisense strategies suppressed IGF1R protein levels to 30,50% of those in control cultures. This was associated with 1.5,2-fold enhancement of sensitivity to cisplatin, mitoxantrone and paclitaxel, and an increase in cisplatin-induced apoptosis. CONCLUSION This approach has potential for development as a clinical treatment for advanced prostate cancer and other chemoresistant tumours. [source]


The pharmacology of the acute hyperthermic response that follows administration of 3,4-methylenedioxymethamphetamine (MDMA, ,ecstasy') to rats

BRITISH JOURNAL OF PHARMACOLOGY, Issue 1 2002
Annis O Mechan
The pharmacology of the acute hyperthermia that follows 3,4-methylenedioxymethamphetamine (MDMA, ,ecstasy') administration to rats has been investigated. MDMA (12.5 mg kg,1 i.p.) produced acute hyperthermia (measured rectally). The tail skin temperature did not increase, suggesting that MDMA may impair heat dissipation. Pretreatment with the 5-HT1/2 antagonist methysergide (10 mg kg,1), the 5-HT2A antagonist MDL 100,907 (0.1 mg kg,1) or the 5-HT2C antagonist SB 242084 (3 mg kg,1) failed to alter the hyperthermia. The 5-HT2 antagonist ritanserin (1 mg kg,1) was without effect, but MDL 11,939 (5 mg kg,1) blocked the hyperthermia, possibly because of activity at non-serotonergic receptors. The 5-HT uptake inhibitor zimeldine (10 mg kg,1) had no effect on MDMA-induced hyperthermia. The uptake inhibitor fluoxetine (10 mg kg,1) markedly attenuated the MDMA-induced increase in hippocampal extracellular 5-HT, also without altering hyperthermia. The dopamine D2 antagonist remoxipride (10 mg kg,1) did not alter MDMA-induced hyperthermia, but the D1 antagonist SCH 23390 (0.3 , 2.0 mg kg,1) dose-dependently antagonized it. The dopamine uptake inhibitor GBR 12909 (10 mg kg,1) did not alter the hyperthermic response and microdialysis demonstrated that it did not inhibit MDMA-induced striatal dopamine release. These results demonstrate that in vivo MDMA-induced 5-HT release is inhibited by 5-HT uptake inhibitors, but MDMA-induced dopamine release may not be altered by a dopamine uptake inhibitor. It is suggested that MDMA-induced hyperthermia results not from MDMA-induced 5-HT release, but rather from the increased release of dopamine that acts at D1 receptors. This has implications for the clinical treatment of MDMA-induced hyperthermia. British Journal of Pharmacology (2002) 135, 170,180; doi:10.1038/sj.bjp.0704442 [source]