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Treatment Site (treatment + site)
Selected AbstractsInfluence of patients' preferences and treatment site on cancer patients' end-of-life care,CANCER, Issue 19 2010Alexi A. Wright MD Abstract BACKGROUND: Research suggests that patients' end-of-life (EOL) care is determined primarily by the medical resources available, and not by patient preferences. The authors examined whether patients' desire for life-extending therapy was associated with their EOL care. METHODS: Coping with Cancer is a multisite, prospective, longitudinal study of patients with advanced cancer. Three hundred one patients were interviewed at baseline and followed until death, a median of 4.5 months later. Multivariate analyses examined the influence of patients' preferences and treatment site on whether patients received intensive care or hospice services in the final week of life. RESULTS: Eighty-three of 301 patients (27.6%) with advanced cancer wanted life-extending therapy at baseline. Patients who understood that their disease was terminal or who reported having EOL discussions with their physicians were less likely to want life-extending care compared with others (23.4% vs 42.6% and 20.7% vs 44.4%, respectively; P , .003). Patients who were treated at Yale Cancer Center received more intensive care (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.16-8.47) and less hospice services (OR, 0.52; 95% CI, 0.29-0.92) compared with patients who were treated at Parkland Hospital. However, in multivariate analyses that controlled for confounding influences, patients who preferred life-extending care were more likely to receive intensive care (adjusted OR [AOR], 2.91; 95% CI, 1.09-7.72) and were less likely to receive hospice services (AOR, 0.45; 95% CI, 0.26-0.78). Treatment site was not identified as a significant predictor of EOL care. CONCLUSIONS: The treatment preferences of patients with advanced cancer may play a more important role in determining the intensity of medical care received at the EOL than previously recognized. Future research is needed to determine the mechanisms by which patients' preferences for care and treatment site interact to influence EOL care. Cancer 2010. © 2010 American Cancer Society. [source] Lidocaine Iontophoresis for Local Anesthesia Before Shave BiopsyDERMATOLOGIC SURGERY, Issue 6 2003William T. Zempsky MD Background. Lidocaine iontophoresis is a method of topical anesthesia in which lidocaine is driven into the skin under the influence of electric current. Objective. To compare lidocaine iontophoresis to placebo for topical anesthesia before shave biopsy in adult patients. Methods. This was a single-center, double-blind, placebo-controlled evaluation of iontophoresis of 2% lidocaine with 1:100,000 epinephrine in patients undergoing shave biopsy. Patients were evaluated for sensation to pinprick after iontophoresis. After completion of the procedure, those patients who did not receive supplemental lidocaine rated the pain associated with the procedure using a 10-cm visual analog scale. The investigator also evaluated the patient's pain after biopsy. Treatment sites were examined for evidence of adverse events such as erythema, urticaria, or burns. Results. Forty-one patients undergoing shave biopsy for evaluation of skin lesions were enrolled. Nineteen of 21 patients in the lidocaine group versus 2 of 20 placebo patients required no supplemental anesthesia (P<0.001). The pain reported by the patient on the visual analog scale subsequent to the procedure was significantly lower in the lidocaine group (P<0.001). In concordance with the results reported by the patients, investigators rated pain lower in the lidocaine group (P<0.001). Blanching and/or erythema occurring at the iontophoresis-treated site in 37 of 41 patients resolved within 1 hour. There were no other treatment-related events. Conclusions. Lidocaine iontophoresis is a safe and effective method of administering topical anesthesia before shave biopsy in adult patients. [source] Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite LaserDERMATOLOGIC SURGERY, Issue 11 2001Sorin Eremia MD Background. Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. Objective. To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I,V. Methods. Eighty-nine untanned patients with skin types I,V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4,6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10,15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm2, a spot size of 12 mm was used for fluences of 35,40 J/cm2, and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm2. Fluences ranging from 20 to 50 J/cm2 (mean fluence 36 J/cm2) were used. Results. The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm2 (35,50 J/cm2) and a 10,12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm2 (30,40 J/cm2) and a 12,15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm2 (25,40 J/cm2) and a 12,15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25,35 J/cm2) and a 12,15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm2 (20,25 J/cm2) and a 12,15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. Conclusion. The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I,V. The best results are achieved in untanned patients with skin types I,IV. [source] Treatment of Lentigo Maligna with Imiquimod before Staged ExcisionDERMATOLOGIC SURGERY, Issue 2 2008MURRAY A. COTTER MD BACKGROUND Imiquimod 5% cream has demonstrated effectiveness in the treatment of lentigo maligna (LM) in several small studies. None of the studies to date have included posttreatment surgical removal to confirm negative histologic margins. OBJECTIVE The aim of this retrospective analysis was to assess the efficacy of topical imiquimod in LM by circumferentially examining vertically oriented sections from a geometrically designed "picture frame" margin as well as bread-loafed sections of the central portion after staged excisions of imiquimod-treated lesions of LM. METHODS Forty patients with biopsy-confirmed LM were treated five times a week for 3 months with 5% imiquimod cream before staged excision. Tazarotene 0.1% gel was added when no clinical signs of erythema developed with imiquimod alone after 1 month (10 patients). After the course of topical therapy, patients were assessed for clinical and complete histologic clearance after staged excision. RESULTS A total of 33 of 40 patients had a complete clinical response as determined by the absence of remaining clinical lesion on physical examination. Upon histologic review, 30 of 40 patients had no evidence of LM whereas 10 of 40 harbored residual disease. One patient was found to have histologic evidence of invasion after completing the topical protocol. After a mean follow-up of 18 months (range, 12,34 months) and after complete surgical excision of the treatment site, none of the imiquimod-treated patients had evidence of recurrence. CONCLUSIONS Imiquimod appears to be an effective adjunctive treatment for LM but does not qualify as a replacement therapy for surgery. [source] Hair Growth Induced by Diode Laser TreatmentDERMATOLOGIC SURGERY, Issue 5 2005Eric F. Bernstein MD background. Although hair reduction by long-pulsed red and infrared lasers and light sources is generally quite effective, paradoxical hair growth has rarely been observed following treatment. objective. To report a case of thick hair growth following 810 nm diode laser treatment and its subsequent treatment. methods. A 24-year-old man who had previously had laser hair reduction on his posterior neck was treated to a test area on his upper back. results. Thick terminal hair developed in the treated area subsequent to laser treatment. Further treatment of this area removed the terminal hair but resulted in terminal hair growth in an annular distribution surrounding the treatment site. conclusions. Diode laser treatment rarely stimulates terminal hair growth. This phenomenon should be studied to better understand hair growth cycles and to help develop more effective treatments for hair loss and hair growth. [source] Effect of Perilesional Injections of PEG-Interleukin-2 on Basal Cell CarcinomaDERMATOLOGIC SURGERY, Issue 11 2000Baruch Kaplan MD Background: Multiple modalities are available for the treatment of basal cell carcinoma (BCC). The most commonly used modalities include simple excision, Mohs micrographic surgery, curettage and electrodessication, cryosurgery, and irradiation therapy. Interleukin-2 (IL-2) is a cytokine produced chiefly by activated T lymphocytes and has effects on various components of the immune system. Until now the primary clinical use of IL-2 has been in advanced stages of metastatic melanoma and renal cell carcinoma. Systemic administration of IL-2 is known to cause significant toxicity. Objective: The objective of this study was to evaluate the therapeutic efficacy and safety of perilesional PEG-IL-2 injections in patients with BCC in an open label, uncontrolled pilot study. Methods: Patients with histologically confirmed primary BCC over 18 years of age were included in the study. Lesions were treated by injecting a total volume of 0.5 cc of IL-2 in a radial fashion in the subcutaneous tissue. Injection dosages ranged from 3000 to 1,200,000 IU in one to four weekly dosages. A total of 12 tumors were treated in eight patients. Results: Overall response rates were as follows: complete response in 8 of 12 treated tumors (66.6% cure rate), partial response in 3 of 12 injected tumors (25% partial response rate), stable disease with no improvement in 1 treatment site (8.4%). Side effects included local pain, swelling, and erythema, and in one patient flulike symptoms. There were no significant changes of blood tests as compared to baseline levels. Conclusions: The therapeutic response induced by perilesional PEG-IL-2 injections was found to be an encouraging, safe, and well-tolerated treatment of BCC. Further studies including a larger patient population and long-term follow-up are necessary in order to substantiate these findings. [source] mTHPC-mediated photodynamic therapy for early oral squamous cell carcinomaINTERNATIONAL JOURNAL OF CANCER, Issue 1 2004Colin Hopper Abstract Surgery and radiotherapy are standard treatments for early oral squamous cell carcinoma, both resulting in good tumour control. However, neither of these modalities is without consequent functional or cosmetic impairment, and there are patients in whom both are contraindicated. Furthermore, there is a significant risk of metachronous tumours developing in the oral cavity, and salvage or retreatment with either surgery or radiotherapy poses difficulties. Photodynamic therapy (PDT) offers the potential for improved functional and cosmetic outcomes, while achieving comparable tumour control. We conducted an open-label, multicentre study to assess the efficacy and safety of meta-tetrahydroxyphenylchlorin (mTHPC) in patients with early oral cancer. One hundred twenty-one patients received intravenously administered mTHPC, followed 96 hr later by illumination of the tumour surface with 652 nm laser light. Of these patients, 114 were protocol compliant. A complete tumour response was achieved in 85% of protocol-compliant patients (97 of 114 patients). A complete response was maintained in 85% of responders at 1 year and in 77% at 2 years. One- and 2-year actuarial survival rates were 89% and 75%, respectively. In the opinion of the investigators, tumour clearance was accompanied by excellent cosmetic and functional results, without impact on the patients' performance status. Mild-to-moderate pain at the treatment site, a recognised side effect of PDT in the oral cavity, was reported by 82% of patients but was manageable with appropriate analgesia. Mild-to-moderate skin photosensitivity reactions were reported for 13% of patients. mTHPC offers an effective alternative treatment for early oral squamous cell carcinoma. It is associated with excellent functional and cosmetic results and can be used in conjunction with other standard therapies. © 2004 Wiley-Liss, Inc. [source] Disruption of axoplasmic transport induces mechanical sensitivity in intact rat C-fibre nociceptor axonsTHE JOURNAL OF PHYSIOLOGY, Issue 2 2008Andrew Dilley Peripheral nerve inflammation can cause axons conducting through the inflamed site to become mechanically sensitive. Axonal mechanical sensitivity (AMS) of intact axons may explain symptoms in a diverse number of conditions characterized by radiating pain evoked by movements of the affected nerve. Because nerve inflammation also disrupts axoplasmic transport, we hypothesized that the disruption of axoplasmic transport by nerve inflammation could cause the cellular components responsible for mechanical transduction to accumulate and become inserted at the inflamed site, causing AMS. This was tested by examining AMS in C-fibre nociceptors following the application of axoplasmic transport blockers (colchicine and vinblastine) to the sciatic nerve. Both 10 mm colchicine and 0.1 mm vinblastine caused AMS to develop in 30.6% and 33.3% of intact axons, respectively (P < 0.05 compared to sham treatment). Since high doses of colchicine (> 50 mm) can damage axons, and inflammation is involved in the removal of axonal debris, experiments were performed to assess conduction across the treatment site as well as signs of inflammation. Results indicated minimal axonal loss (95% of A- and C-fibres conducting), consistent with the normal microscopic appearance of the colchicine treatment site and absence of ED1-positive (recruited) macrophages. In a separate series of experiments, the block of axoplasmic transport proximal to a localized neuritis significantly reduced inflammation-induced AMS (15.6% compared to 55.6%; P < 0.05), further supporting that the components necessary for AMS are moved by anterograde transport. In summary, nerve inflammation that causes the disruption of axoplasmic transport in patients with painful conditions may result in the accumulation and insertion of mechanosensitive elements at the inflamed site. [source] Successful treatment of lymphomatoid papulosis with photodynamic therapyAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2009Michelle Rodrigues ABSTRACT A 40-year-old woman presented with a prolonged history of recurrent crops of erythematous papules and nodules on her abdomen, arms and legs. Histological examination of a cutaneous biopsy revealed Type A lymphomatoid papulosis. Over a 3-year period, some of the patient's lesions had proven to be resistant to treatment with topical and intralesional corticosteroids and systemic agents including methotrexate, tetracycline and nicotinamide. These resistant lesions were treated with two sessions of methyl aminolevulinate photodynamic therapy given 1 week apart. Review 11 months post-photodynamic therapy demonstrated complete clinical clearance at the treatment site. While photodynamic therapy is considered a standard non-surgical treatment option for non-melanoma skin cancers and has been described in a number of non-oncological indications, this is the first report of its use in lymphomatoid papulosis. [source] Pyogenic granuloma complicating pulsed-dye laser therapy for cherry angiomaAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2009Sheryn Cheah ABSTRACT A 37 year-old-woman presented for cosmetic removal of a 7-mm (diameter) cherry angioma on her right anterior thigh. Various treatment options were discussed and removal of the lesion using pulsed-dye laser was carried out. The patient returned 5 weeks later complaining of bleeding from the treatment site, which on examination showed a 23 × 23-mm friable nodular lesion with the typical appearance of a pyogenic granuloma. This lesion was removed by shave excision, curettage and electrodessication. Histopathological examination confirmed the diagnosis of pyogenic granuloma. This is a rare occurrence post pulsed-dye laser therapy that physicians may choose to discuss with patients prior to performing this procedure. [source] Influence of patients' preferences and treatment site on cancer patients' end-of-life care,CANCER, Issue 19 2010Alexi A. Wright MD Abstract BACKGROUND: Research suggests that patients' end-of-life (EOL) care is determined primarily by the medical resources available, and not by patient preferences. The authors examined whether patients' desire for life-extending therapy was associated with their EOL care. METHODS: Coping with Cancer is a multisite, prospective, longitudinal study of patients with advanced cancer. Three hundred one patients were interviewed at baseline and followed until death, a median of 4.5 months later. Multivariate analyses examined the influence of patients' preferences and treatment site on whether patients received intensive care or hospice services in the final week of life. RESULTS: Eighty-three of 301 patients (27.6%) with advanced cancer wanted life-extending therapy at baseline. Patients who understood that their disease was terminal or who reported having EOL discussions with their physicians were less likely to want life-extending care compared with others (23.4% vs 42.6% and 20.7% vs 44.4%, respectively; P , .003). Patients who were treated at Yale Cancer Center received more intensive care (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.16-8.47) and less hospice services (OR, 0.52; 95% CI, 0.29-0.92) compared with patients who were treated at Parkland Hospital. However, in multivariate analyses that controlled for confounding influences, patients who preferred life-extending care were more likely to receive intensive care (adjusted OR [AOR], 2.91; 95% CI, 1.09-7.72) and were less likely to receive hospice services (AOR, 0.45; 95% CI, 0.26-0.78). Treatment site was not identified as a significant predictor of EOL care. CONCLUSIONS: The treatment preferences of patients with advanced cancer may play a more important role in determining the intensity of medical care received at the EOL than previously recognized. Future research is needed to determine the mechanisms by which patients' preferences for care and treatment site interact to influence EOL care. Cancer 2010. © 2010 American Cancer Society. [source] In vivo Remote Delivery of DNA Encoding for Hypoxia-inducible Factor 1 Alpha Reduces Myocardial Infarct SizeCLINICAL AND TRANSLATIONAL SCIENCE, Issue 1 2009Gabor Czibik M.D. Abstract We tested if remote gene delivery of hypoxia-inducible factor 1 alpha (HIF-1,) protected hearts against induced ischemia, hypothesizing that gene delivery into skeletal muscle may lead to secretion of proteins with actions elsewhere. Murine quadriceps muscles were transfected with DNA encoding for human HIF-1,, which resulted in a local, but lasting expression (mRNA and protein, where the latter had nuclear localization). Subjection of isolated hearts to global ischemia and reperfusion 1, 4, and 8 weeks after gene delivery resulted in infarct size reduction (p < 0.05). Supporting that this was due to paracrine effects, HL-1 cells treated with conditioned media from cells transfected with HIF-1, or serum from HIF-1,-treated mice were protected against H2O2 -induced cell death (p < 0.05, respectively). The latter protection was reduced when a heme oxygenase activity blocker was used. Taqman low-density array of 47 HIF-1,-regulated genes at the treatment site showed nine specific upregulations (p < 0.05). Of the corresponding proteins, PDGF-B and adrenomedullin were upregulated in the heart. HIF-1, treatment induced an increased vascularization of the heart and skeletal muscle. In conclusion, remote delivery of DNAfor HIF-1, was cardioprotective, represented by consistent infarct size reduction, which may be due to release of paracrine factors from the transfected muscle. [source] The added risk of opioid problem use among treatment-seeking youth with marijuana and/or alcohol problem useADDICTION, Issue 4 2010Geetha A. Subramaniam Abstract Objectives To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU). Methods A total of 475 youth (ages 14,21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment-funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated. Results The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex-related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15,17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services. Conclusions These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment-seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth. [source] RESEARCH REPORT Alcoholism treatment and medical care costs from Project MATCHADDICTION, Issue 7 2000Harold D. Holder Aims. This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. Design Longitudinal study with pre- and post-treatment initiation. Measurements. The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. Setting. Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). Participants. Two hundred and seventy-nine patients. Intervention. Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. Findings. Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF., Conclusions. Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment. [source] Levels of aloe mortality with and without elephants in the Thicket Biome of South AfricaAFRICAN JOURNAL OF ECOLOGY, Issue 2 2009D. M. Parker Abstract Studies concerning the influence of African elephants (Loxodonta africana) on vegetation have produced contradictory results; some show minimal or no effect while others report significant elephant-induced effects. Elephants are generalist megaherbivores but will selectively feed from preferred plant species. We investigated the mortality of aloe plants (highly preferred food items for elephants) at five sites with elephants (treatment) and five paired sites without elephants (control) in the Eastern Cape Province of South Africa. A significantly higher proportion of aloes were dead at treatment sites and significantly more aloes that had lost their crown (headless) were found at treatment sites compared with controls. We conclude that although the proportions of dead aloes at treatment sites were significantly higher, it remains unclear whether there is a need to be concerned with the potential small-scale extinction of aloes from parts of the Eastern Cape Province. The observed mortality may merely be an artefact of the loss of large herbivores through disease (e.g. rinderpest) and hunting in the past. Résumé Des études de l'influence des éléphants africains (Loxodonta africana) sur la végétation ont produit des résultats contradictoires: certaines montrent un effet minimal, voire nul, alors que d'autres signalent des effets significatifs. Les éléphants sont des grands herbivores généralistes, mais ils se nourrissent sélectivement de certaines parties des plantes. Nous avons étudié la mortalité de plants d'aloès (nourriture fortement privilégiée par les éléphants) à cinq sites avec éléphants (traitement) et à cinq autres sites sans éléphant (témoins), dans la Province du Cap oriental, en Afrique du Sud. Il y avait une proportion significativement plus grande d'aloès morts dans les sites du traitement, et ils étaient significativement plus nombreux à avoir perdu leur couronne (étêtés) que dans les sites témoins. Nous concluons que, bien que la proportion d'aloès morts soit significativement plus grande dans les sites du traitement, il n'est pas évident de savoir s'il faut s'inquiéter de cette possible extinction à petite échelle des aloès dans certaines parties de la Province du Cap oriental. La mortalité observée peut bien être simplement un artefact de la perte des grands herbivores en raison de maladies (ex. la peste bovine) et de la chasse dans le passé. [source] Help seeking and satisfaction among Latinas: The roles of setting, ethnic identity, and therapeutic allianceJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2005Manuel Paris Jr. This study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of acculturation, and satisfaction with services among 103 women. We explored the nature of the therapeutic relationship and satisfaction with services among Latinas who received behavioral health services at: (1) a community behavioral health center, (2) a community health center, and (3) a faith-based agency. Overall, results demonstrated that participants had strong therapeutic alliances and were satisfied with services at the three different treatment sites. Differences noted, including clinical and research implications, are also described. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 299,312, 2005. [source] Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2009W Manuskiatti Abstract Background, A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect and/or delayed therapeutic outcome. Objective, To determine the safety and efficacy of the TriPollar radiofrequency device for cellulite treatment and circumference reduction. Methods, Thirty-nine females with cellulite received eight weekly TriPollar treatments. Treatment areas included the abdomen, thighs, buttocks and arms. Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a quartile grading scale was recorded. Results, Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen (P = 0.002) and thigh (P = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were demonstrated (P = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were noted. Conclusions, Tripollar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference and cellulite appearance. Conflict of Interest The authors have no financial interest in this article. [source] Design and testing of biological scaffolds for delivering reparative cells to target sites in the lung,JOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE, Issue 4 2010Edward P. Ingenito Abstract This study summarizes the development and testing of a scaffold to promote engraftment of cells in the distal lung. A fibrinogen,fibronectin,vitronectin hydrogel (FFVH) was developed and optimized with respect to its mechanical and biological properties for this application. In vitro, FFVH scaffolds promoted attachment, histiotypic growth and expression of basement membrane proteins by primary ovine lung mesenchymal cells derived from lung biopsies. In vivo testing was then performed to assess the ability of FFVHs to promote cell engraftment in the sheep lung. Treatment with autologous cells delivered using FFVH was clinically well tolerated. Cells labelled with a fluorescent dye (PKH-26) were detected at treatment sites after 1 month. Tissue mass (assessed by CT imaging) and lung perfusion (assessed by nuclear scintigraphy) were increased at emphysema test sites. Post-treatment histology demonstrated cell proliferation and increased elastin expression without scarring or collapse. No treatment-related pathology was observed at healthy control sites. FFVH scaffolds promote cell attachment, spreading and extracellular matrix expression in vitro and apparent engraftment in vivo, with evidence of trophic effects on the surrounding tissue. Scaffolds of this type may contribute to the development of cell-based therapies for patients with end-stage pulmonary diseases. Copyright © 2009 John Wiley & Sons, Ltd. [source] Profiles of Self-Reported HIV-Risk Behaviors Among Injection Drug Users in Methadone Maintenance Treatment, Detoxification, and Needle Exchange ProgramsPUBLIC HEALTH NURSING, Issue 1 2006Hayley Diana Mark ABSTRACT Objective: Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program. Design: A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. Sample and Measurements: Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania. Results: Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites. Conclusions: Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g. IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs. [source] An Evaluation of Fibrin Tissue Adhesive Concentration and Application Thickness on Skin Graft SurvivalTHE LARYNGOSCOPE, Issue 11 2000Kevin M. O'Grady BS Abstract Objectives To e-amine the effects of fibrinogen concentration and application thickness of fibrin tissue adhesive on skin graft survival. Study Design Prospective controlled study. Methods Ten domestic pigs were included in the study. A 20 , 5-cm area of skin was harvested bilaterally along the flanks of the animals using a Padgett dermatome. The harvested grafts were trimmed into four 4 , 4-cm squares. Donor sites were treated according to group assignment and the non-meshed grafts were placed on the side opposite their initial orientation and secured with staples. Both single- and multiple-donor human fibrin tissue adhesive preparations, with low and high average fibrinogen concentrations of 30 mg/mL and 60 mg/mL, were used. Adhesive preparations were applied in either a thin layer (0.015 mL/cm2) or a thick layer (0.06 mL/cm2) using a spray applicator. A constant thrombin concentration of 10 U/mL was used in the study. No adhesive was used in the control group and grafts were stabilized with staples. No topical dressings were applied to any of the treatment sites. Animals were sacrificed 4 weeks after graft application. Results Based on statistical analysis, thickness of adhesive application had a significant effect on skin graft survival. Percent mean graft survival in the control and thin application groups was found to be 92% and 97.8% respectively; the mean survival rate in the thick application group was 63.1%. Fibrinogen concentration, when evaluated independently within the thin and thick application groups, was found to have no significant effect on graft survival. Conclusion Independent of fibrinogen concentration, a thin layer of fibrin tissue adhesive, when applied between two opposing surfaces, does not interfere with and may support the healing process, whereas a thick layer of adhesive inhibits skin graft healing. [source] Plasma facilitated delivery of DNA to skinBIOTECHNOLOGY & BIOENGINEERING, Issue 5 2009Richard J. Connolly Abstract Non-viral delivery of cell-impermeant drugs and DNA in vivo has traditionally relied upon either chemical or physical stress applied directly to target tissues. Physical methods typically use contact between an applicator, or electrode, and the target tissue and may involve patient discomfort. To overcome contact-dependent limitations of such delivery methodologies, an atmospheric helium plasma source was developed to deposit plasma products onto localized treatment sites. Experiments performed in murine skin showed that samples injected with plasmid DNA encoding luciferase and treated with plasma demonstrated increased levels of expression relative to skin samples that received injections of DNA alone. Increased response relative to injection alone was observed when either positive or negative voltage was used to generate the helium plasma. Quantitative results over a 26-day follow-up period showed that luciferase levels as high as 19-fold greater than the levels obtained by DNA injection alone could be achieved. These findings indicate that plasmas may compete with other physical delivery methodologies when skin is the target tissue. Biotechnol. Bioeng. 2009; 104: 1034,1040. © 2009 Wiley Periodicals, Inc. [source] Qualitative Data Collection and Analysis Methods: The INSTINCT TrialACADEMIC EMERGENCY MEDICINE, Issue 11 2007William J. Meurer MD Patient care practices often lag behind current scientific evidence and professional guidelines. The failure of such knowledge translation (KT) efforts may reflect inadequate assessment and management of specific barriers confronting both physicians and patients at the point of treatment level. Effective KT in this setting may benefit from the use of qualitative methods to identify and overcome these barriers. Qualitative methodology allows in-depth exploration of the barriers involved in adopting practice change and has been infrequently used in emergency medicine research. The authors describe the methodology for qualitative analysis within the INcreasing Stroke Treatment through INteractive behavioral Change Tactics (INSTINCT) trial. This includes processes for valid data collection and reliable analysis of the textual data from focus group and interview transcripts. INSTINCT is a 24-hospital, randomized, controlled study that is designed to evaluate a system-based barrier assessment and interactive educational intervention to increase appropriate tissue plasminogen activator (tPA) use in ischemic stroke. Intervention hospitals undergo baseline barrier assessment using both qualitative as well as quantitative (survey) techniques. Investigators obtain data on local barriers to tPA use, as well as information on local attitudes, knowledge, and beliefs regarding acute stroke treatment. Targeted groups at each site include emergency physicians, emergency nurses, neurologists, radiologists, and hospital administrators. Transcript analysis using NVivo7 with a predefined barrier taxonomy is described. This will provide both qualitative insight on thrombolytic use and importance of specific barrier types for each site. The qualitative findings subsequently direct the form of professional education efforts and system interventions at treatment sites. [source] | |||||||||||||||||||||||||