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Sample records for particle therapy review

  1. Particle therapy

    SciTech Connect

    Raju, M.R.

    1993-09-01

    Particle therapy has a long history. The experimentation with particles for their therapeutic application got started soon after they were produced in the laboratory. Physicists played a major role in proposing the potential applications in radiotherapy as well as in the development of particle therapy. A brief review of the current status of particle radiotherapy with some historical perspective is presented and specific contributions made by physicists will be pointed out wherever appropriate. The rationale of using particles in cancer treatment is to reduce the treatment volume to the target volume by using precise dose distributions in three dimensions by using particles such as protons and to improve the differential effects on tumors compared to normal tissues by using high-LET radiations such as neutrons. Pions and heavy ions combine the above two characteristics.

  2. Charged Particle Radiation Therapy for Uveal Melanoma: A Systematic Review and Meta-Analysis

    SciTech Connect

    Wang, Zhen; Nabhan, Mohammed; Schild, Steven E.; Stafford, Scott L.; Petersen, Ivy A.; Foote, Robert L.; Murad, M. Hassan

    2013-05-01

    Charged particle therapy (CPT) delivered with either protons, helium ions, or carbon ions, has been used to treat uveal melanoma. The present analysis was performed to systematically evaluate the efficacy and adverse effects of CPT for uveal melanoma. We searched EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and SciVerse Scopus and cross-referenced recent systematic reviews through January 2012. Two independent reviewers identified clinical trials and observational studies of CPT (protons, helium ions, and carbon ions). These reviewers extracted data and assessed study quality. Twenty-seven studies enrolling 8809 uveal melanoma patients met inclusion criteria. The rate of local recurrence was significantly less with CPT than with brachytherapy (odds ratio [OR] = 0.22, 95% confidence interval [CI], 0.21-0.23). There were no significant differences in mortality or enucleation rates. Results were robust in multiple sensitivity analyses. CPT was also associated with lower retinopathy and cataract formation rates. Data suggest better outcomes may be possible with charged particle therapy with respect to local recurrence, retinopathy, and cataract formation rates. The overall quality of the evidence is low, and higher quality comparative effectiveness studies are needed to provide better evidence.

  3. Particle Radiation Therapy: Requiem or Reveille

    PubMed Central

    Alexander, Leslie L.; Goldson, Alfred L.; Alexander, George A.

    1979-01-01

    The 1960s and 1970s witnessed a surge of many institutions devoted to electron therapy. Currently, many facilities are adding or have added particle types of radiation to their armamentarium against cancer. The authors review the concepts, problems, and potentials of this form of therapy. ImagesFigure 1 PMID:423289

  4. Particle therapy for noncancer diseases

    SciTech Connect

    Bert, Christoph; Engenhart-Cabillic, Rita; Durante, Marco

    2012-04-15

    Radiation therapy using high-energy charged particles is generally acknowledged as a powerful new technique in cancer treatment. However, particle therapy in oncology is still controversial, specifically because it is unclear whether the putative clinical advantages justify the high additional costs. However, particle therapy can find important applications in the management of noncancer diseases, especially in radiosurgery. Extension to other diseases and targets (both cranial and extracranial) may widen the applications of the technique and decrease the cost/benefit ratio of the accelerator facilities. Future challenges in this field include the use of different particles and energies, motion management in particle body radiotherapy and extension to new targets currently treated by catheter ablation (atrial fibrillation and renal denervation) or stereotactic radiation therapy (trigeminal neuralgia, epilepsy, and macular degeneration). Particle body radiosurgery could be a future key application of accelerator-based particle therapy facilities in 10 years from today.

  5. Basics of particle therapy I: physics

    PubMed Central

    Park, Seo Hyun

    2011-01-01

    With the advance of modern radiation therapy technique, radiation dose conformation and dose distribution have improved dramatically. However, the progress does not completely fulfill the goal of cancer treatment such as improved local control or survival. The discordances with the clinical results are from the biophysical nature of photon, which is the main source of radiation therapy in current field, with the lower linear energy transfer to the target. As part of a natural progression, there recently has been a resurgence of interest in particle therapy, specifically using heavy charged particles, because these kinds of radiations serve theoretical advantages in both biological and physical aspects. The Korean government is to set up a heavy charged particle facility in Korea Institute of Radiological & Medical Sciences. This review introduces some of the elementary physics of the various particles for the sake of Korean radiation oncologists' interest. PMID:22984664

  6. Cancer Therapy with Particle Beams

    E-print Network

    Olszewski Jr., Edward A.

    Cancer Therapy with Particle Beams #12;· The potential to use high energy particle beams to treat many types of cancer has been known even before their creation. · The availability of these treatments to be used in medicine, specifically for the treatment of certain cancers. His paper was published when

  7. Comparison of particle-radiation-therapy modalities

    SciTech Connect

    Fairchild, R.G.; Bond, V.P.

    1981-01-01

    The characteristics of dose distribution, beam alignment, and radiobiological advantages accorded to high LET radiation were reviewed and compared for various particle beam radiotherapeutic modalities (neutron, Auger electrons, p, ..pi../sup -/, He, C, Ne, and Ar ions). Merit factors were evaluated on the basis of effective dose to tumor relative to normal tissue, linear energy transfer (LET), and dose localization, at depths of 1, 4, and 10 cm. In general, it was found that neutron capture therapy using an epithermal neutron beam provided the best merit factors available for depths up to 8 cm. The position of fast neutron therapy on the Merit Factor Tables was consistently lower than that of other particle modalities, and above only /sup 60/Co. The largest body of clinical data exists for fast neutron therapy; results are considered by some to be encouraging. It then follows that if benefits with fast neutron therapy are real, additional gains are within reach with other modalities.

  8. Charged Particle Therapy for Hepatocellular Carcinoma

    PubMed Central

    Skinner, Heath D.; Hong, Theodore S.; Krishnan, Sunil

    2011-01-01

    Historically, the use of external beam radiotherapy for hepatocellular carcinoma (HCC) has been limited by toxicity to the uninvolved liver and surrounding structures. Advances in photon radiotherapy have improved dose conformality to the tumor and facilitated dose escalation, a key contributor to improved HCC radiation treatment outcomes. However, despite these advances in photon radiotherapy, significant volumes of liver still receive low doses of radiation that can preclude dose escalation, particularly in patients with limited functional liver reserves. By capitalizing on the lack of exit dose along the beam path beyond the tumor and higher biological effectiveness, charged particle therapy offers the promise of maximizing tumor control via dose escalation without excessive liver toxicity. In this review we discuss the distinctive biophysical attributes of both proton and carbon ion radiotherapy, particularly as they pertain to treatment of HCC. We also review the available literature regarding clinical outcomes and toxicity of using charged particles for the treatment of HCC. PMID:21939857

  9. The Particle Therapy Cancer Research Institute is a member of

    E-print Network

    ;Oxford Precision Medicine Institute Genomics Particle Therapy Robotic Surgery Functional and Molecular, open treatment room - 3D imagining, ex-room, no patient movement Hypo-Fractionation - High current CW Projection screens provide easy review of therapy information Open room provides clear access for lasers

  10. Play Therapy: A Review

    ERIC Educational Resources Information Center

    Porter, Maggie L.; Hernandez-Reif, Maria; Jessee, Peggy

    2009-01-01

    This article discusses the current issues in play therapy and its implications for play therapists. A brief history of play therapy is provided along with the current play therapy approaches and techniques. This article also touches on current issues or problems that play therapists may face, such as interpreting children's play, implementing…

  11. Indoor particles: a review.

    PubMed

    Wallace, L

    1996-02-01

    This paper reviews studies of particle concentrations and sources in homes and buildings. Three major studies of indoor and outdoor concentrations in U.S. homes are summarized in detail and compared. A number of smaller studies in homes are also briefly summarized. One study of 38 buildings and several smaller studies of buildings are also reviewed. All major studies found that an important indoor source of fine and coarse particles was cigarette smoking, with estimated increases in homes with smokers ranging from 25 to 45 micrograms/m3 PM2.5. Several studies identified cooking as a second important source. All of the three major studies found a substantial portion of indoor particles to be due to unexplained indoor sources, suggesting a topic for future research. One study also found a large unexplained increase in personal exposure to PM10 compared to concurrent indoor or outdoor concentrations--the so-called "personal cloud," a second topic for further research. The impact of outdoor air particles on indoor concentrations was considered. Equilibrium mass balance models indicate that this is a function of the penetration P through the building envelope, the air exchange rate a, and the particle decay rate k. EPA's PTEAM Study provided an estimate for k of 0.39 h-1 for fine particles and 1.01 h-1 for coarse particles. Two studies suggest that P = 1 for PM10. Using these results, the fraction of outdoor air PM2.5 and PM10 particles found indoors at a given air exchange rate can be calculated. The protective effect of reducing air exchange rates during periods of high outdoor particle pollution can thus be quantified. PMID:8846246

  12. Review of Particle Physics

    NASA Astrophysics Data System (ADS)

    Olive, K. A.; Particle Data Group

    2014-08-01

    The Review summarizes much of particle physics and cosmology. Using data from previous editions, plus 3,283 new measurements from 899 papers, we list, evaluate, and average measured properties of gauge bosons and the recently discovered Higgs boson, leptons, quarks, mesons, and baryons. We summarize searches for hypothetical particles such as heavy neutrinos, supersymmetric and technicolor particles, axions, dark photons, etc. All the particle properties and search limits are listed in Summary Tables. We also give numerous tables, figures, formulae, and reviews of topics such as Supersymmetry, Extra Dimensions, Particle Detectors, Probability, and Statistics. Among the 112 reviews are many that are new or heavily revised including those on: Dark Energy, Higgs Boson Physics, Electroweak Model, Neutrino Cross Section Measurements, Monte Carlo Neutrino Generators, Top Quark, Dark Matter, Dynamical Electroweak Symmetry Breaking, Accelerator Physics of Colliders, High-Energy Collider Parameters, Big Bang Nucleosynthesis, Astrophysical Constants and Cosmological Parameters. All tables, listings, and reviews (and errata) are also available on the Particle Data Group website: http://pdg.lbl.gov. Contents Abstract, Contributors, Highlights and Table of ContentsAcrobat PDF (4.4 MB) IntroductionAcrobat PDF (595 KB) Particle Physics Summary Tables Gauge and Higgs bosonsAcrobat PDF (204 KB) LeptonsAcrobat PDF (167 KB) QuarksAcrobat PDF (115 KB) MesonsAcrobat PDF (976 KB) BaryonsAcrobat PDF (384 KB) Searches (Supersymmetry, Compositeness, etc.)Acrobat PDF (120 KB) Tests of conservation lawsAcrobat PDF (383 KB) Reviews, Tables, and Plots Detailed contents for this sectionAcrobat PDF (73 KB) Constants, Units, Atomic and Nuclear PropertiesAcrobat PDF (395 KB) Standard Model and Related TopicsAcrobat PDF (8.37 MB) Astrophysics and CosmologyAcrobat PDF (3.79 MB) Experimental Methods and CollidersAcrobat PDF (3.82 MB) Mathematical Tools of Statistics, Monte Carlo, Group Theory Acrobat PDF (1.77 MB) Kinematics, Cross-Section Formulae, and PlotsAcrobat PDF (3.57 MB) Particle Listings Illustrative key and abbreviationsAcrobat PDF (325 KB) Gauge and Higgs bosonsAcrobat PDF (2.38 MB) LeptonsAcrobat PDF (2.03 MB) QuarksAcrobat PDF (1.51 MB) Mesons: Light unflavored and strangeAcrobat PDF (4.91 MB) Mesons: Charmed and bottomAcrobat PDF (9.03 MB) Mesons: OtherAcrobat PDF (4.03 MB) BaryonsAcrobat PDF (4.54 MB) Miscellaneous searchesAcrobat PDF (3.98 MB) IndexAcrobat PDF (276 KB)

  13. Molecular Targeted ?-Particle Therapy for Oncologic Applications

    PubMed Central

    Wadas, Thaddeus J.; Pandya, Darpan N.; Solingapuram Sai, Kiran Kumar; Mintz, Akiva

    2015-01-01

    OBJECTIVE A significant challenge facing traditional cancer therapies is their propensity to significantly harm normal tissue. The recent clinical success of targeting therapies by attaching them to antibodies that are specific to tumor-restricted biomarkers marks a new era of cancer treatments. CONCLUSION In this article, we highlight the recent developments in ?-particle therapy that have enabled investigators to exploit this highly potent form of therapy by targeting tumor-restricted molecular biomarkers. PMID:25055256

  14. Promise and Pitfalls of Heavy-Particle Therapy

    PubMed Central

    Mitin, Timur; Zietman, Anthony L.

    2014-01-01

    Proton beam therapy, the most common form of heavy-particle radiation therapy, is not a new invention, but it has gained considerable public attention because of the high cost of installing and operating the rapidly increasing number of treatment centers. This article reviews the physical properties of proton beam therapy and focuses on the up-to-date clinical evidence comparing proton beam therapy with the more standard and widely available radiation therapy treatment alternatives. In a cost-conscious era of health care, the hypothetical benefits of proton beam therapy will have to be supported by demonstrable clinical gains. Proton beam therapy represents, through its scale and its cost, a battleground for the policy debate around managing expensive technology in modern medicine. PMID:25113772

  15. Gantry for medical particle therapy facility

    DOEpatents

    Trbojevic, Dejan (Wading River, NY)

    2012-05-08

    A particle therapy gantry for delivering a particle beam to a patient includes a beam tube having a curvature defining a particle beam path and a plurality of fixed field magnets sequentially arranged along the beam tube for guiding the particle beam along the particle path. In a method for delivering a particle beam to a patient through a gantry, a particle beam is guided by a plurality of fixed field magnets sequentially arranged along a beam tube of the gantry and the beam is alternately focused and defocused with alternately arranged focusing and defocusing fixed field magnets.

  16. Gantry for medical particle therapy facility

    DOEpatents

    Trbojevic, Dejan

    2013-04-23

    A particle therapy gantry for delivering a particle beam to a patient includes a beam tube having a curvature defining a particle beam path and a plurality of superconducting, variable field magnets sequentially arranged along the beam tube for guiding the particle beam along the particle path. In a method for delivering a particle beam to a patient through a gantry, a particle beam is guided by a plurality of variable field magnets sequentially arranged along a beam tube of the gantry and the beam is alternately focused and defocused with alternately arranged focusing and defocusing variable field magnets.

  17. Particle Radiation Therapy for Gastrointestinal Malignancies

    PubMed Central

    Meyer, Jeffrey J.; Willett, Christopher G.

    2007-01-01

    Treatment-related toxicity is common in the radiotherapeutic management of cancers of the gastrointestinal tract. These toxicities can diminish treatment efficacy by necessitating treatment breaks, limiting the radiation dose that can be delivered, and hindering concomitant use of chemotherapy and targeted drug agents. Many efforts have focused on widening the gap between the likelihood of tumor control and the likelihood of toxicities associated with radiation. Use of particles that exhibit a Bragg peak phenomenon in their interactions with tissue, such as protons, heavier ions like carbon ions, and pions, is one means of concentrating radiation dose in tumors and away from normal tissues. Neutron beams have also been used in the treatment of gastrointestinal cancers in an effort to take advantage of their potent biologic effects. This report reviews basic particle radiation physics and biology, as well as the clinical experience with protons, heavier ions, pions, and neutrons in the treatment of various gastrointestinal malignancies. Potential future directions in clinical research with particle therapy are discussed. PMID:19360149

  18. Massage therapy research review.

    PubMed

    Field, Tiffany

    2014-11-01

    Moderate pressure massage has contributed to many positive effects including increased weight gain in preterm infants, reduced pain in different syndromes including fibromyalgia and rheumatoid arthritis, enhanced attentiveness, reduced depression and enhanced immune function (increased natural killer cells and natural killer cell activity).Surprisingly, these recent studies have not been reviewed, highlighting the need for the current review. When moderate and light pressure massage have been compared in laboratory studies, moderate pressure massage reduced depression, anxiety and heart rate, and it altered EEG patterns, as in a relaxation response. Moderate pressure massage has also led to increased vagal activity and decreased cortisol levels. Functional magnetic resonance imaging data have suggested that moderate pressure massage was represented in several brain regions including the amygdala, the hypothalamus and the anterior cingulate cortex, all areas involved in stress and emotion regulation. Further research is needed to identify underlying neurophysiological and biochemical mechanisms associated with moderate pressure massage. PMID:25172313

  19. Hyperpigmentation Therapy: A Review

    PubMed Central

    Desai, Seemal R.

    2014-01-01

    With an increasing number of multicultural patients and those of different backgrounds presenting in dermatology clinics, issues facing patients with higher Fitzpatrick skin classifications, often referred to as skin of color patients, are on the rise. Knowledge of the diagnostic dilemmas, cutting edge treatment options, and latest clinical research in the diagnosis and management of cutaneous anomalies in skin of color patients is of paramount importance. Of the most common complaints in patients with skin of color is hyperpigmentation. Despite the availability of multiple treatments for the condition, hyperpigmentation continues to present clinical management challenges for dermatologists. Difficulty may be traced to physician or patient reluctance to use certain agents or interventions, failure to identify and avoid contributing factors, and insufficient attention paid to the psychosocial aspects of the disease. This review addresses a variety of issues including the diagnosis and management of hyperpigmentation. PMID:25161755

  20. Review of Particle Physics

    E-print Network

    Nakamura, Kenzo

    2010-01-01

    nuclear physics experiments: http://www.ppdg.net/ Online particle physics information Particle Physics Education: ArtNuclear Research (CERN) which is the world’s largest particle physics center: http://public.web.cern.ch/public/about/how/art/

  1. Life Review: Implementation, Theory, Research, and Therapy

    ERIC Educational Resources Information Center

    Haber, David

    2006-01-01

    A selective literature review of publications on life review generated ideas on implementation, theory, research, and therapy. The review begins by differentiating life review from reminiscence, and summarizing ways to conduct a life review. A dozen theories that have been influenced by the life review technique are presented, with a focus placed…

  2. [Proton therapy and particle accelerators].

    PubMed

    Fukumoto, Sadayoshi

    2012-01-01

    Since the high energy accelerator plan was changed from a 40 GeV direct machine to a 12GeV cascade one, a 500 MeV rapid cycling booster synchrotron was installed between the injector linac and the 12 GeV main ring at KEK, National Lab. for High Energy Physics. The booster beams were used not only for injection to the main ring but also for medical use. Their energy was reduced to 250 MeV by a graphite block for clinical trial of cancer therapy. In 1970's, pi(-) or heavy ions were supposed to be promising. Although advantage of protons with Bragg Peak was pointed out earlier, they seemed effective only for eye melanoma at that time. In early 1980's, it was shown that they were effective for deep-seated tumor by Tsukuba University with KEK beams. The first dedicated facility was built at Loma Linda University Medical Center. Its synchrotron was made by Fermi National Accelerator Lab. Since a non-resonant accelerating rf cavity was installed, operation of the synchrotron became much easier. Later, innovation of the cyclotron was achieved. Its weight was reduced from 1,000 ton to 200 ton. Some of the cyclotrons are equipped with superconducting coils. PMID:24592677

  3. Value-Free Therapy?: An Empirical Review.

    ERIC Educational Resources Information Center

    Gram, Anita M.

    This paper reviews the literature dealing with therapist neutrality or value-free treatment processes, and proposes that therapist values do play a major role in therapy. Supposed therapist neutrality in psychoanalyses, behavior therapy, and client-centered therapy is explored. The role of therapist values in client selection is discussed, and the…

  4. Magnetic particle hyperthermia—a promising tumour therapy?

    NASA Astrophysics Data System (ADS)

    Dutz, Silvio; Hergt, Rudolf

    2014-11-01

    We present a critical review of the state of the art of magnetic particle hyperthermia (MPH) as a minimal invasive tumour therapy. Magnetic principles of heating mechanisms are discussed with respect to the optimum choice of nanoparticle properties. In particular, the relation between superparamagnetic and ferrimagnetic single domain nanoparticles is clarified in order to choose the appropriate particle size distribution and the role of particle mobility for the relaxation path is discussed. Knowledge of the effect of particle properties for achieving high specific heating power provides necessary guidelines for development of nanoparticles tailored for tumour therapy. Nanoscale heat transfer processes are discussed with respect to the achievable temperature increase in cancer cells. The need to realize a well-controlled temperature distribution in tumour tissue represents the most serious problem of MPH, at present. Visionary concepts of particle administration, in particular by means of antibody targeting, are far from clinical practice, yet. On the basis of current knowledge of treating cancer by thermal damaging, this article elucidates possibilities, prospects, and challenges for establishment of MPH as a standard medical procedure.

  5. Magnetic particle hyperthermia--a promising tumour therapy?

    PubMed

    Dutz, Silvio; Hergt, Rudolf

    2014-11-14

    We present a critical review of the state of the art of magnetic particle hyperthermia (MPH) as a minimal invasive tumour therapy. Magnetic principles of heating mechanisms are discussed with respect to the optimum choice of nanoparticle properties. In particular, the relation between superparamagnetic and ferrimagnetic single domain nanoparticles is clarified in order to choose the appropriate particle size distribution and the role of particle mobility for the relaxation path is discussed. Knowledge of the effect of particle properties for achieving high specific heating power provides necessary guidelines for development of nanoparticles tailored for tumour therapy. Nanoscale heat transfer processes are discussed with respect to the achievable temperature increase in cancer cells. The need to realize a well-controlled temperature distribution in tumour tissue represents the most serious problem of MPH, at present. Visionary concepts of particle administration, in particular by means of antibody targeting, are far from clinical practice, yet. On the basis of current knowledge of treating cancer by thermal damaging, this article elucidates possibilities, prospects, and challenges for establishment of MPH as a standard medical procedure. PMID:25337919

  6. Novel technologies in charged particle therapy

    NASA Astrophysics Data System (ADS)

    Peach, K. J.

    2011-05-01

    Charged Particle Therapy (the use of protons and other light ions such as carbon to treat certain forms of cancer) is experiencing a rapid expansion in many parts of the world, and there are now more than 30 such centres operating in hospitals. The current technologies available use cyclotrons and synchrotrons to deliver the dose to the cancer. While each of these technologies is mature, and capable of treating cancer successfully, there is always room for improvement in technique, to reduce costs, increase throughput and availability and improve outcomes. This talk will discuss some recent development, using both traditional and laser-based accelerator techniques.

  7. Modelling and Dosimetry for Alpha-Particle Therapy

    PubMed Central

    Sgouros, George; Hobbs, Robert F.; Song, Hong

    2015-01-01

    As a consequence of the high potency and short range of alpha-particles, radiopharmaceutical therapy with alpha-particle emitting radionuclides is a promising treatment approach that is under active pre-clinical and clinical investigation. To understand and predict the biological effects of alpha-particle radiopharmaceuticals, dosimetry is required at the micro or multi-cellular scale level. At such a scale, highly non-uniform irradiation of the target volume may be expected and the utility of a single absorbed dose value to predict biological effects comes into question. It is not currently possible to measure the pharmacokinetic input required for micro scale dosimetry in humans. Accordingly, pre-clinical studies are required to provide the pharmacokinetic data for dosimetry calculations. The translation of animal data to the human requires a pharmacokinetic model that links macro- and micro-scale pharmacokinetics thereby enabling the extrapolation of micro-scale kinetics from macroscopic measurements. These considerations along with a discussion of the appropriate physical quantity and related units for alpha-particle radiopharmaceutical therapy are examined in this review. PMID:22201712

  8. Surgery and complementary therapies: a review.

    PubMed

    Petry, J J

    2000-09-01

    The incorporation of complementary therapies into the surgical setting has been slow compared to that of other areas of conventional medicine. This paper summarizes the available information on complementary therapies in surgery from a broad range of sources in the medical literature. The effects of psychological distress on the surgical patient and potential relief from that distress by such methods as relaxation techniques, hypnosis, suggestion, and imagery, as well as the role of coping style and locus of control on choice of therapy are reviewed. The role of acupuncture, music, massage therapy, therapeutic touch, and Reiki, as well as the use of herbs and supplements in modifying surgical outcome, is explored. PMID:10979163

  9. Molecular Pathways: Targeted ?-Particle Radiation Therapy

    PubMed Central

    Baidoo, Kwamena E.; Yong, Kwon; Brechbiel, Martin W.

    2012-01-01

    An ?-particle, a 4He nucleus, is exquisitely cytotoxic, and indifferent to many limitations associated with conventional chemo- and radiotherapy. The exquisite cytotoxicity of ? radiation, the result of its high mean energy deposition (high linear energy transfer, LET) and limited range in tissue, provides for a highly controlled therapeutic modality that can be targeted to selected malignant cells (targeted ?-therapy (TAT)) with minimal normal tissue effects. There is a burgeoning interest in the development of TAT that is buoyed by the increasing number of ongoing clinical trials worldwide. The short path length renders ?-emitters suitable for treatment and management of minimal disease such as micrometastases or residual tumor after surgical debulking, hematological cancers, infections, and compartmental cancers such as ovarian cancer or neoplastic meningitis. Yet, despite decades of study of high-LET radiation, the mechanistic pathways of the effects of this modality remain not well defined. The modality is effectively presumed to follow a simple therapeutic mechanism centered on catastrophic double strand (ds) DNA breaks without full examination of the actual molecular pathways and targets that are activated that directly impact cell survival or death. This Molecular Pathways article provides an overview of the mechanisms and pathways that are involved in the response to and repair of TAT induced DNA damage as currently understood. Finally, this article highlights the current state of clinical translation of TAT as well as other high-LET radionuclide radiation therapy using ?-emitters such as 225Ac, 211At, 213Bi, 212Pb and 223Ra. PMID:23230321

  10. Reducing the uncertainties in particle therapy

    SciTech Connect

    Oancea, C.; Shipulin, K. N.; Mytsin, G. V.; Luchin, Y. I.

    2015-02-24

    The use of fundamental Nuclear Physics in Nuclear Medicine has a significant impact in the fight against cancer. Hadrontherapy is an innovative cancer radiotherapy method using nuclear particles (protons, neutrons and ions) for the treatment of early and advanced tumors. The main goal of proton therapy is to deliver high radiation doses to the tumor volume with minimal damage to healthy tissues and organs. The purpose of this work was to investigate the dosimetric errors in clinical proton therapy dose calculation due to the presence of metallic implants in the treatment plan, and to determine the impact of the errors. The results indicate that the errors introduced by the treatment planning systems are higher than 10% in the prediction of the dose at isocenter when the proton beam is passing directly through a metallic titanium alloy implant. In conclusion, we recommend that pencil-beam algorithms not be used when planning treatment for patients with titanium alloy implants, and to consider implementing methods to mitigate the effects of the implants.

  11. Reducing the uncertainties in particle therapy

    NASA Astrophysics Data System (ADS)

    Oancea, C.; Shipulin, K. N.; Mytsin, G. V.; Luchin, Y. I.

    2015-02-01

    The use of fundamental Nuclear Physics in Nuclear Medicine has a significant impact in the fight against cancer. Hadrontherapy is an innovative cancer radiotherapy method using nuclear particles (protons, neutrons and ions) for the treatment of early and advanced tumors. The main goal of proton therapy is to deliver high radiation doses to the tumor volume with minimal damage to healthy tissues and organs. The purpose of this work was to investigate the dosimetric errors in clinical proton therapy dose calculation due to the presence of metallic implants in the treatment plan, and to determine the impact of the errors. The results indicate that the errors introduced by the treatment planning systems are higher than 10% in the prediction of the dose at isocenter when the proton beam is passing directly through a metallic titanium alloy implant. In conclusion, we recommend that pencil-beam algorithms not be used when planning treatment for patients with titanium alloy implants, and to consider implementing methods to mitigate the effects of the implants.

  12. Hepatocellular Carcinoma Radiation Therapy: Review of Evidence and Future Opportunities

    SciTech Connect

    Klein, Jonathan

    2013-09-01

    Hepatocellular carcinoma (HCC) is a leading cause of global cancer death. Curative therapy is not an option for most patients, often because of underlying liver disease. Experience in radiation therapy (RT) for HCC is rapidly increasing. Conformal RT can deliver tumoricidal doses to focal HCC with low rates of toxicity and sustained local control in HCC unsuitable for other locoregional treatments. Stereotactic body RT and particle therapy have been used with long-term control in early HCC or as a bridge to liver transplant. RT has also been effective in treating HCC with portal venous thrombosis. Patients with impaired liver function and extensive disease are at increased risk of toxicity and recurrence. More research on how to combine RT with other standard and novel therapies is warranted. Randomized trials are also needed before RT will be generally accepted as a treatment option for HCC. This review discusses the current state of the literature and opportunities for future research.

  13. Effects of voice therapy: a systematic review.

    PubMed

    Speyer, R

    2008-09-01

    Medical as well as paramedical treatments should be evaluated by scientific methods. This systematic review focuses on the effects of voice therapy, excluding pharmacological or surgical treatments. In general, statistically significant positive but modest and varying therapy effects are found. Many of these effect studies cope with diverse methodological problems. Furthermore, the conclusions of most studies cannot be generalized easily or compared to one another. As a consequence, many issues in the field of effects of voice therapy have yet been unanswered. PMID:17509828

  14. Respiratory motion management in particle therapy

    SciTech Connect

    Rietzel, Eike; Bert, Christoph

    2010-02-15

    Clinical outcomes of charged particle therapy are very promising. Currently, several dedicated centers that use scanning beam technology are either close to clinical use or under construction. Since scanned beam treatments of targets that move with respiration most likely result in marked local over- and underdosage due to interplay of target motion and dynamic beam application, dedicated motion mitigation techniques have to be employed. To date, the motion mitigation techniques, rescanning, beam gating, and beam tracking, have been proposed and tested in experimental studies. Rescanning relies on repeated irradiations of the target with the number of particles reduced accordingly per scan to statistically average local misdosage. Specific developments to prohibit temporal correlation between beam scanning and target motion will be required to guarantee adequate averaging. For beam gating, residual target motion within gating windows has to be mitigated in order to avoid local misdosage. Possibly the most promising strategy is to increase the overlap of adjacent particle pencil beams laterally as well as longitudinally to effectively reduce the sensitivity against small residual target motion. The most conformal and potentially most precise motion mitigation technique is beam tracking. Individual particle pencil beams have to be adapted laterally as well as longitudinally according to the target motion. Within the next several years, it can be anticipated that rescanning as well as beam gating will be ready for clinical use. For rescanning, treatment planning margins that incorporate the full extent of target motion as well as motion induced density variations in the beam paths will result in reduced target conformity of the applied dose distributions. Due to the limited precision of motion monitoring devices, it seems likely that beam gating will be used initially to mitigate interplay effects only but not to considerably decrease treatment planning margins. Then, in the next step, beam gating, based on more accurate motion monitoring systems, provides the possibility to restore target conformity as well as steep dose gradients due to reduced treatment planning margins. Accurate motion monitoring systems will be required for beam tracking. Even though beam tracking has already been successfully tested experimentally, full clinical implementation requires direct feedback of the actual target position in quasireal time to the treatment control system and can be anticipated to be several more years ahead.

  15. Ozone therapy: A clinical review

    PubMed Central

    Elvis, A. M.; Ekta, J. S.

    2011-01-01

    Ozone (O3) gas discovered in the mid-nineteenth century is a molecule consisting of three atoms of oxygen in a dynamically unstable structure due to the presence of mesomeric states. Although O3 has dangerous effects, yet researchers believe it has many therapeutic effects. Ozone therapy has been utilized and heavily studied for more than a century. Its effects are proven, consistent, safe and with minimal and preventable side effects. Medical O3 is used to disinfect and treat disease. Mechanism of actions is by inactivation of bacteria, viruses, fungi, yeast and protozoa, stimulation of oxygen metabolism, activation of the immune system. Medication forms in a gaseous state are somewhat unusual, and it is for this reason that special application techniques have had to be developed for the safe use of O3. In local applications as in the treatment of external wounds, its application in the form of a transcutaneous O3 gas bath has established itself as being the most practical and useful method, for example at low (sub-atmospheric) pressure in a closed system guaranteeing no escape of O3 into the surrounding air. Ozonized water, whose use is particularly known in dental medicine, is optimally applied as a spray or compress. Diseases treated are infected wounds, circulatory disorders, geriatric conditions, macular degeneration, viral diseases, rheumatism/arthritis, cancer, SARS and AIDS. PMID:22470237

  16. Magnetic field therapy: a review.

    PubMed

    Markov, Marko S

    2007-01-01

    There is increasing interest in using permanent magnets for therapeutic purposes encouraged by basic science publications and clinical reports. Magnetotherapy provides a non invasive, safe, and easy method to directly treat the site of injury, the source of pain and inflammation, and other types of disease. The physiological bases for the use of magnetic fields for tissue repair as well as physical principles of dosimetry and application of various magnetic fields are subjects of this review. Analysis of the magnetic and electromagnetic stimulation is followed by a discussion of the advantage of magnetic field stimulation compared with electric current and electric field stimulation. PMID:17454079

  17. Recent advances in massage therapy - a review.

    PubMed

    Liu, S-L; Qi, W; Li, H; Wang, Y-F; Yang, X-F; Li, Z-M; Lu, Q; Cong, D-Y

    2015-10-01

    Massage therapy is one of the most widely accepted alternative form of medicine helping patients suffering from varied pathological states including arthritis, anxiety, sleep problems, pain management and injury repair. Besides this, it is one of the safest forms of alternative medicine and has become favorite among various health care professionals. However, there is still a lot of debate is going in medical world pertaining to its certain use in modern medicine. So, the present review shall enlighten all the latest aspects of massage therapy in current medicine. PMID:26531268

  18. A Systematic Review of Randomized Controlled Studies of Art Therapy

    ERIC Educational Resources Information Center

    Maujean, Annick; Pepping, Christopher A.; Kendall, Elizabeth

    2014-01-01

    This review article examines current knowledge about the efficacy of art therapy based on the findings of 8 randomized controlled trials (RCTs) conducted with adult populations from 2008-2013 that met a high standard of rigor. Of these studies, all but one reported beneficial effects of art therapy. Review findings suggest that art therapy may…

  19. Review of pharmacological therapies in fibromyalgia syndrome

    PubMed Central

    2014-01-01

    This review addresses the current status of drug therapy for the management of fibromyalgia syndrome (FMS) and is based on interdisciplinary FMS management guidelines, meta-analyses of drug trial data, and observational studies. In the absence of a single gold-standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence. Drug therapy is not mandatory for the management of FMS. Pregabalin, duloxetine, milnacipran, and amitriptyline are the current first-line prescribed agents but have had a mostly modest effect. With only a minority of patients expected to experience substantial benefit, most will discontinue therapy because of either a lack of efficacy or tolerability problems. Many drug treatments have undergone limited study and have had negative results. It is unlikely that these failed pilot trials will undergo future study. However, medications, though imperfect, will continue to be a component of treatment strategy for these patients. Both the potential for medication therapy to relieve symptoms and the potential to cause harm should be carefully considered in their administration. PMID:24433463

  20. Scanning systems for particle cancer therapy

    DOEpatents

    Trbojevic, Dejan

    2015-08-04

    A particle beam to treat malignant tissue is delivered to a patient by a gantry. The gantry includes a plurality of small magnets sequentially arranged along a beam tube to transfer the particle beam with strong focusing and a small dispersion function, whereby a beam size is very small, allowing for the small magnet size. Magnets arranged along the beam tube uses combined function magnets where the magnetic field is a combination of a bending dipole field with a focusing or defocusing quadrupole field. A triplet set of combined function magnets defines the beam size at the patient. A scanning system of magnets arranged along the beam tube after the bending system delivers the particle beam in a direction normal to the patient, to minimize healthy skin and tissue exposure to the particle beam.

  1. Biological therapy and dentistry: a review paper.

    PubMed

    Radfar, Lida; Ahmadabadi, Roshanak E; Masood, Farah; Scofield, R Hal

    2015-11-01

    In recent years, a new class of drugs has revolutionized the treatment of autoimmune, allergic, infectious, and many more diseases. This new class of drugs is made of 3 groups-cytokines, monoclonal antibodies, and fusion proteins-that may target special damaged cells but not all the cells. These drugs may have side effects such as infection, hypersensitivity, hematologic disorders, cancer, hepatotoxicity, and neurologic disorders. However, there is not enough evidence or long-term studies of the mechanism of action and side effects of these drugs. Patients receiving biological therapies may need special consideration in dentistry. This paper is a review of the classification, mechanism of action, and side effects of these drugs and dental consideration for patients receiving biological therapies. PMID:26372436

  2. Review of Particle Physics, 2012-2013

    E-print Network

    Beringer, J; Barnett, R M; Copic, K; Dahl, O; Groom, D E; Lin, C J; Lys, J; Murayama, H; Wohl, C G; Yao, W M; Zyla, P A; Amsler, C; Antonelli, M; Asner, D M; Baer, H; Band, H R; Basaglia, T; Bauer, C W; Beatty, J J; Belousov, V I; Bergren, E; Bernardi, G; Bertl, W; Bethke, S; Bichsel, H; Biebel, O; Blucher, E; Blusk, S; Brooijmans, G; Buchmueller, O; Cahn, R N; Carena, M; Ceccucci, A; Chakraborty, D; Chen, M C; Chivukula, R S; Cowan, G; D'Ambrosio, G; Damour, T; de Florian, D; de Gouvea, A; DeGrand, T; de Jong, P; Dissertori, G; Dobrescu, B; Doser, M; Drees, M; Edwards, D A; Eidelman, S; Erler, J; Ezhela, V V; Fetscher, W; Fields, B D; Foster, B; Gaisser, T K; Garren, L; Gerber, H J; Gerbier, G; Gherghetta, T; Golwala, S; Goodman, M; Grab, C; Gritsan, A V; Grivaz, J F; Grunewald, M; Gurtu, A; Gutsche, T; Haber, H E; Hagiwara, K; Hagmann, C; Hanhart, C; Hashimoto, S; Hayes, K G; Heffner, M; Heltsley, B; Hernandez-Rey, J J; Hikasa, K; Hocker, A; Holder, J; Holtkamp, A; Huston, J; Jackson, J D; Johnson, K F; Junk, T; Karlen, D; Kirkby, D; Klein, S R; Klempt, E; Kowalewski, R V; Krauss, F; Kreps, M; Krusche, B; Kuyanov, Yu.V; Kwon, Y; Lahav, O; Laiho, J; Langacker, P; Liddle, A; Ligeti, Z; Liss, T M; Littenberg, L; Lugovsky, K S; Lugovsky, S B; Mannel, T; Manohar, A V; Marciano, W J; Martin, A D; Masoni, A; Matthews, J; Milstead, D; Miquel, R; Monig, K; Moortgat, F; Nakamura, K; Narain, M; Nason, P; Navas, S; Neubert, M; Nevski, P; Nir, Y; Olive, K A; Pape, L; Parsons, J; Patrignani, C; Peacock, J A; Petcov, S T; Piepke, A; Pomarol, A; Punzi, G; Quadt, A; Raby, S; Raffelt, G; Ratcliff, B N; Richardson, P; Roesler, S; Rolli, S; Romaniouk, A; Rosenberg, L J; Rosner, J L; Sachrajda, C T; Sakai, Y; Salam, G P; Sarkar, S; Sauli, F; Schneider, O; Scholberg, K; Scott, D; Seligman, W G; Shaevitz, M H; Sharpe, S R; Silari, M; Sjostrand, T; Skands, P; Smith, J G; Smoot, G F; Spanier, S; Spieler, H; Stahl, A; Stanev, T; Stone, S L; Sumiyoshi, T; Syphers, M J; Takahashi, F; Tanabashi, M; Terning, J; Titov, M; Tkachenko, N P; Tornqvist, N A; Tovey, D; Valencia, G; van Bibber, K; Venanzoni, G; Vincter, M G; Vogel, P; Vogt, A; Walkowiak, W; Walter, C W; Ward, D R; Watari, T; Weiglein, G; Weinberg, E J; Wiencke, L R; Wolfenstein, L; Womersley, J; Woody, C L; Workman, R L; Yamamoto, A; Zeller, G P; Zenin, O V; Zhang, J; Zhu, R Y; Harper, G; Lugovsky, V S; Schaffner, P

    2012-01-01

    This biennial Review summarizes much of particle physics. Using data from previous editions, plus 2658 new measurements from 644 papers, we list, evaluate, and average measured properties of gauge bosons, leptons, quarks, mesons, and baryons. We summarize searches for hypothetical particles such as Higgs bosons, heavy neutrinos, and supersymmetric particles. All the particle properties and search limits are listed in Summary Tables. We also give numerous tables, figures, formulae, and reviews of topics such as the Standard Model, particle detectors, probability, and statistics. Among the 112 reviews are many that are new or heavily revised including those on Heavy-Quark and Soft-Collinear Effective Theory, Neutrino Cross Section Measurements, Monte Carlo Event Generators, Lattice QCD, Heavy Quarkonium Spectroscopy, Top Quark, Dark Matter, Vcb & Vub, Quantum Chromodynamics, High-Energy Collider Parameters, Astrophysical Constants, Cosmological Parameters, and Dark Matter.

  3. Review: Stem cells and gene therapy.

    PubMed

    Alenzi, Faris Q; Lotfy, Mahmoud; Tamimi, Waleed G; Wyse, Richard K H

    2010-09-01

    Both stem cell and gene therapy research are currently the focus of intense research in institutions and companies around the world. Both approaches hold great promise by offering radical new and successful ways of treating debilitating and incurable diseases effectively. Gene therapy is an approach to treat, cure, or ultimately prevent disease by changing the pattern of gene expression. It is mostly experimental, but a number of clinical human trials have already been conducted. Gene therapy can be targeted to somatic or germ cells; the most common vectors are viruses. Scientists manipulate the viral genome and thus introduce therapeutic genes to the target organ. Viruses, in this context, can cause adverse events such as toxicity, immune and inflammatory responses, as well as gene control and targeting issues. Alternative modalities being considered are complexes of DNA with lipids and proteins. Stem cells are primitive cells that have the capacity to self renew as well as to differentiate into 1 or more mature cell types. Pluripotent embryonic stem cells derived from the inner cell mass can develop into more than 200 different cells and differentiate into cells of the 3 germ cell layers. Because of their capacity of unlimited expansion and pluripotency, they are useful in regenerative medicine. Tissue or adult stem cells produce cells specific to the tissue in which they are found. They are relatively unspecialized and predetermined to give rise to specific cell types when they differentiate. The current review provides a summary of our current knowledge of stem cells and gene therapy as well as their clinical implications and related therapeutic options. PMID:20858588

  4. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and...

  5. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and...

  6. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and...

  7. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and...

  8. Detection object of life review therapy for automatic record generating

    NASA Astrophysics Data System (ADS)

    Sakamoto, Kunio; Otsuka, Tomonori

    2009-10-01

    The authors have researched a support system of the reminiscence and life review activity. In this life review therapy, it is important to review the sessions after the activity for an effective therapy. Therefore therapists must keep a record of sessions for inspection of methods and ways of valuation on reminiscence and life review therapy, but it is trouble for the therapists to record. To overcome this problem, we have developed an automatic generating system of reports about life review activities. In this paper, we describe the support system which can automatically write down a session report about the activity.

  9. MINI REVIEW MODIFIED ADENOVIRUSES FOR CANCER GENE THERAPY

    E-print Network

    Hemminki, Akseli

    MINI REVIEW MODIFIED ADENOVIRUSES FOR CANCER GENE THERAPY Anna KANERVA 1­3 and Akseli HEMMINKI 1,2 * 1 Cancer Gene Therapy Group, Rational Drug Design, Biomedicum Helsinki, University of Helsinki of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland Adenoviral gene therapy

  10. Preterm infant massage therapy research: a review.

    PubMed

    Field, Tiffany; Diego, Miguel; Hernandez-Reif, Maria

    2010-04-01

    In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies. PMID:20137814

  11. Preterm Infant Massage Therapy Research: A Review

    PubMed Central

    Field, Tiffany; Diego, Miguel; Hernandez-Reif, Maria

    2010-01-01

    In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies. PMID:20137814

  12. Realizing the potential of the Actinium-225 radionuclide generator in targeted alpha-particle therapy applications

    PubMed Central

    Miederer, Matthias; Scheinberg, David A.; McDevitt, Michael R.

    2013-01-01

    Alpha particle-emitting isotopes have been proposed as novel cytotoxic agents for augmenting targeted therapy. Properties of alpha particle radiation such as their limited range in tissue of a few cell diameters and their high linear energy transfer leading to dense radiation damage along each alpha track are promising in the treatment of cancer, especially when single cells or clusters of tumor cells are targeted. Actinium-225 (225Ac) is an alpha particle-emitting radionuclide that generates 4 net alpha particle isotopes in a short decay chain to stable 209Bi, and as such can be described as an alpha particle nanogenerator. This article reviews the literature pertaining to the research, development, and utilization of targeted 225Ac to potently and specifically affect cancer. PMID:18514364

  13. Realizing the potential of the Actinium-225 radionuclide generator in targeted alpha particle therapy applications.

    PubMed

    Miederer, Matthias; Scheinberg, David A; McDevitt, Michael R

    2008-09-01

    Alpha particle-emitting isotopes have been proposed as novel cytotoxic agents for augmenting targeted therapy. Properties of alpha particle radiation such as their limited range in tissue of a few cell diameters and their high linear energy transfer leading to dense radiation damage along each alpha track are promising in the treatment of cancer, especially when single cells or clusters of tumor cells are targeted. Actinium-225 (225 Ac) is an alpha particle-emitting radionuclide that generates 4 net alpha particle isotopes in a short decay chain to stable 209 Bi, and as such can be described as an alpha particle nanogenerator. This article reviews the literature pertaining to the research, development, and utilization of targeted 225 Ac to potently and specifically affect cancer. PMID:18514364

  14. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display...

  15. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display...

  16. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display...

  17. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display...

  18. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display...

  19. Glycolic acid peel therapy - a current review.

    PubMed

    Sharad, Jaishree

    2013-01-01

    Chemical peels have been time-tested and are here to stay. Alpha-hydroxy peels are highly popular in the dermatologist's arsenal of procedures. Glycolic acid peel is the most common alpha-hydroxy acid peel, also known as fruit peel. It is simple, inexpensive, and has no downtime. This review talks about various studies of glycolic acid peels for various indications, such as acne, acne scars, melasma, postinflammatory hyperpigmentation, photoaging, and seborrhea. Combination therapies and treatment procedure are also discussed. Careful review of medical history, examination of the skin, and pre-peel priming of skin are important before every peel. Proper patient selection, peel timing, and neutralization on-time will ensure good results, with no side effects. Depth of the glycolic acid peel depends on the concentration of the acid used, the number of coats applied, and the time for which it is applied. Hence, it can be used as a very superficial peel, or even a medium depth peel. It has been found to be very safe with Fitzpatrick skin types I-IV. All in all, it is a peel that is here to stay. PMID:24399880

  20. Glycolic acid peel therapy – a current review

    PubMed Central

    Sharad, Jaishree

    2013-01-01

    Chemical peels have been time-tested and are here to stay. Alpha-hydroxy peels are highly popular in the dermatologist’s arsenal of procedures. Glycolic acid peel is the most common alpha-hydroxy acid peel, also known as fruit peel. It is simple, inexpensive, and has no downtime. This review talks about various studies of glycolic acid peels for various indications, such as acne, acne scars, melasma, postinflammatory hyperpigmentation, photoaging, and seborrhea. Combination therapies and treatment procedure are also discussed. Careful review of medical history, examination of the skin, and pre-peel priming of skin are important before every peel. Proper patient selection, peel timing, and neutralization on-time will ensure good results, with no side effects. Depth of the glycolic acid peel depends on the concentration of the acid used, the number of coats applied, and the time for which it is applied. Hence, it can be used as a very superficial peel, or even a medium depth peel. It has been found to be very safe with Fitzpatrick skin types I–IV. All in all, it is a peel that is here to stay. PMID:24399880

  1. Range Verification Methods in Particle Therapy: Underlying Physics and Monte Carlo Modeling

    PubMed Central

    Kraan, Aafke Christine

    2015-01-01

    Hadron therapy allows for highly conformal dose distributions and better sparing of organs-at-risk, thanks to the characteristic dose deposition as function of depth. However, the quality of hadron therapy treatments is closely connected with the ability to predict and achieve a given beam range in the patient. Currently, uncertainties in particle range lead to the employment of safety margins, at the expense of treatment quality. Much research in particle therapy is therefore aimed at developing methods to verify the particle range in patients. Non-invasive in vivo monitoring of the particle range can be performed by detecting secondary radiation, emitted from the patient as a result of nuclear interactions of charged hadrons with tissue, including ?+ emitters, prompt photons, and charged fragments. The correctness of the dose delivery can be verified by comparing measured and pre-calculated distributions of the secondary particles. The reliability of Monte Carlo (MC) predictions is a key issue. Correctly modeling the production of secondaries is a non-trivial task, because it involves nuclear physics interactions at energies, where no rigorous theories exist to describe them. The goal of this review is to provide a comprehensive overview of various aspects in modeling the physics processes for range verification with secondary particles produced in proton, carbon, and heavier ion irradiation. We discuss electromagnetic and nuclear interactions of charged hadrons in matter, which is followed by a summary of some widely used MC codes in hadron therapy. Then, we describe selected examples of how these codes have been validated and used in three range verification techniques: PET, prompt gamma, and charged particle detection. We include research studies and clinically applied methods. For each of the techniques, we point out advantages and disadvantages, as well as clinical challenges still to be addressed, focusing on MC simulation aspects. PMID:26217586

  2. Gene therapy for gastric cancer: A review

    PubMed Central

    Zhang, Chao; Liu, Zhan-Kui

    2003-01-01

    Gastric cancer is common in China, and its early diagnosis and treatment are difficult. In recent years great progress has been achieved in gene therapy, and a wide array of gene therapy systems for gastric cancer has been investigated. The present article deals with the general principles of gene therapy and then focuses on how these principles may be applied to gastric cancer. PMID:14606062

  3. An Updated Review of the Efficacy of Cupping Therapy

    PubMed Central

    Cao, Huijuan; Li, Xun; Liu, Jianping

    2012-01-01

    Background Since 1950, traditional Chinese medicine (TCM) cupping therapy has been applied as a formal modality in hospitals throughout China and elsewhere in the world. Based on a previous systematic literature review of clinical studies on cupping therapy, this study presents a thorough review of randomized controlled trials (RCTs) to evaluate the therapeutic effect of cupping therapy. Method Six databases were searched for articles published through 2010. RCTs on cupping therapy for various diseases were included. Studies on cupping therapy combined with other TCM treatments versus non-TCM therapies were excluded. Results 135 RCTs published from 1992 through 2010 were identified. The studies were generally of low methodological quality. Diseases for which cupping therapy was commonly applied were herpes zoster, facial paralysis (Bell palsy), cough and dyspnea, acne, lumbar disc herniation, and cervical spondylosis. Wet cupping was used in most trials, followed by retained cupping, moving cupping, and flash cupping. Meta-analysis showed cupping therapy combined with other TCM treatments was significantly superior to other treatments alone in increasing the number of cured patients with herpes zoster, facial paralysis, acne, and cervical spondylosis. No serious adverse effects were reported in the trials. Conclusions Numerous RCTs on cupping therapy have been conducted and published during the past decades. This review showed that cupping has potential effect in the treatment of herpes zoster and other specific conditions. However, further rigorously designed trials on its use for other conditions are warranted. PMID:22389674

  4. Development of 2D Ionization Chamber for Particle Therapy

    NASA Astrophysics Data System (ADS)

    Ho, Chi-Li

    2010-11-01

    Recently rapid growth in particle therapy has imposed new detector developments for quality assurance (QA) purposes. Relatively high dose deposition from proton or carbon ion beam requires stringent performance from detectors. Cyclotron, synchrotron, or future laser driven accelerators represent DC and pulse sources which need different timing designs in electronics. Dose and position measurements of particle beams can serve clinical, beam diagnosis and QA purposes. We categorize the parameters of detectors - electronics, DAQ, and simulation--to serve for later optimizations. Gaseous detector is preferred because of its radiation hardness, and operation at ionization mode provides stable condition. We present our progresses in 2D ionization chamber development. Basic studies are carried out on 1D ionization chamber, which consists of 16 6-mm-wide strips. Results of measuring electron and proton beams are compared with MC simulations. 2D array ionization chamber design is optimized and based on 1D prototype measurements.

  5. Combination therapy for erectile dysfunction: an update review

    PubMed Central

    Dhir, Rohit R; Lin, Hao-Cheng; Canfield, Steven E; Wang, Run

    2011-01-01

    The introduction of oral phosphodiesterase-5 inhibitors (PDE5Is) in the late 1990s and early 2000s revolutionized the field of sexual medicine and PDE5Is are currently first-line monotherapy for erectile dysfunction (ED). However, a significant proportion of patients with complex ED will be therapeutic non-responders to PDE5I monotherapy. Combination therapy has recently been adopted for more refractory cases of ED, but a critical evaluation of current combination therapies is lacking. A thorough PubMed and Cochrane Library search was conducted focusing on the effectiveness of combination therapies for ED in therapeutic non-responders to PDE5I therapy. Journal articles spanning the time period between January 1990 and December 2010 were reviewed. Criteria included all pertinent review articles, randomized controlled trials, cohort studies and retrospective analyses. References from retrieved articles were also manually scanned for additional relevant publications. Published combination therapies include PDE5I plus vacuum erectile device (VED), intraurethral medication, intracavernosal injection (ICI), androgen supplement, ?-blocker or miscellaneous combinations. Based on this review, some of these combination treatments appeared to be quite effective in preliminary testing. Caution must be advised, however, as the majority of combination therapy articles in the last decade have numerous limitations including study biases and small subject size. Regardless of limitations, present combination therapy research provides a solid foundation for future studies in complex ED management. PMID:21423198

  6. Maggot debridement therapy: a systematic review.

    PubMed

    Shi, Eric; Shofler, David

    2014-12-01

    Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care markets. It promotes wound healing by performing three key processes: debridement, disinfection and growth-promoting activity. It can be used for the debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic of post-surgical wounds. With the increase in chronic diabetic foot wounds, maggot debridement therapy is a promising tool for health professionals dealing with difficult wounds. This article presents an overview of the research evidence surrounding maggot debridement therapy that serves as a guide to health professionals who may be users of this form of treatment now and in the future. PMID:25478859

  7. Proton Radiation Therapy for Head and Neck Cancer: A Review of the Clinical Experience to Date

    SciTech Connect

    Holliday, Emma B.; Frank, Steven J.

    2014-06-01

    Proton beam radiation has been used for cancer treatment since the 1950s, but recent increasing interest in this form of therapy and the construction of hospital-based and clinic-based facilities for its delivery have greatly increased both the number of patients and the variety of tumors being treated with proton therapy. The mass of proton particles and their unique physical properties (ie, the Bragg peak) allow proton therapy to spare normal tissues distal to the tumor target from incidental irradiation. Initial observations show that proton therapy is particularly useful for treating tumors in challenging locations close to nontarget critical structures. Specifically, improvements in local control outcomes for patients with chordoma, chonodrosarcoma, and tumors in the sinonasal regions have been reported in series using proton. Improved local control and survival outcomes for patients with cancer of the head and neck region have also been seen with the advent of improvements in better imaging and multimodality therapy comprising surgery, radiation therapy, and chemotherapy. However, aggressive local therapy in the proximity of critical normal structures to tumors in the head and neck region may produce debilitating early and late toxic effects. Great interest has been expressed in evaluating whether proton therapy can improve outcomes, especially early and late toxicity, when used in the treatment of head and neck malignancies. This review summarizes the progress made to date in addressing this question.

  8. Charged Particle Therapy with Mini-Segmented Beams

    PubMed Central

    Dilmanian, F. Avraham; Eley, John G.; Rusek, Adam; Krishnan, Sunil

    2015-01-01

    One of the fundamental attributes of proton therapy and carbon ion therapy is the ability of these charged particles to spare tissue distal to the targeted tumor. This significantly reduces normal tissue toxicity and has the potential to translate to a wider therapeutic index. Although, in general, particle therapy also reduces dose to the proximal tissues, particularly in the vicinity of the target, dose to the skin and to other very superficial tissues tends to be higher than that of megavoltage x-rays. The methods presented here, namely, “interleaved carbon minibeams” and “radiosurgery with arrays of proton and light ion minibeams,” both utilize beams segmented into arrays of parallel “minibeams” of about 0.3?mm incident-beam size. These minibeam arrays spare tissues, as demonstrated by synchrotron x-ray experiments. An additional feature of particle minibeams is their gradual broadening due to multiple Coulomb scattering as they penetrate tissues. In the case of interleaved carbon minibeams, which do not broaden much, two arrays of planar carbon minibeams that remain parallel at target depth, are aimed at the target from 90° angles and made to “interleave” at the target to produce a solid radiation field within the target. As a result, the surrounding tissues are exposed only to individual carbon minibeam arrays and are therefore spared. The method was used in four-directional geometry at the NASA Space Radiation Laboratory to ablate a 6.5-mm target in a rabbit brain at a single exposure with 40?Gy physical absorbed dose. Contrast-enhanced magnetic resonance imaging and histology 6-month later showed very focal target necrosis with nearly no damage to the surrounding brain. As for minibeams of protons and light ions, for which the minibeam broadening is substantial, measurements at MD Anderson Cancer Center in Houston, TX, USA; and Monte Carlo simulations showed that the broadening minibeams will merge with their neighbors at a certain tissue depth to produce a solid beam to treat the target. The resulting sparing of proximal normal tissue allows radiosurgical ablative treatments with smaller impact on the skin and shallow tissues. This report describes these two methods and discusses their potential clinical applications. PMID:26649281

  9. review The American Society of Gene & Cell Therapy Molecular Therapy vol. 20 no. 4, 699708 apr. 2012 699

    E-print Network

    review© The American Society of Gene & Cell Therapy Molecular Therapy vol. 20 no. 4, 699­708 apr clinical trials for gene therapy of inherited and acquired diseases using first generation AAV2 vectors-related macular degeneration.2 Perhaps the most striking example of successful gene therapy in a clinical setting

  10. Spatial mapping of the biologic effectiveness of scanned particle beams: towards biologically optimized particle therapy.

    PubMed

    Guan, Fada; Bronk, Lawrence; Titt, Uwe; Lin, Steven H; Mirkovic, Dragan; Kerr, Matthew D; Zhu, X Ronald; Dinh, Jeffrey; Sobieski, Mary; Stephan, Clifford; Peeler, Christopher R; Taleei, Reza; Mohan, Radhe; Grosshans, David R

    2015-01-01

    The physical properties of particles used in radiation therapy, such as protons, have been well characterized, and their dose distributions are superior to photon-based treatments. However, proton therapy may also have inherent biologic advantages that have not been capitalized on. Unlike photon beams, the linear energy transfer (LET) and hence biologic effectiveness of particle beams varies along the beam path. Selective placement of areas of high effectiveness could enhance tumor cell kill and simultaneously spare normal tissues. However, previous methods for mapping spatial variations in biologic effectiveness are time-consuming and often yield inconsistent results with large uncertainties. Thus the data needed to accurately model relative biological effectiveness to guide novel treatment planning approaches are limited. We used Monte Carlo modeling and high-content automated clonogenic survival assays to spatially map the biologic effectiveness of scanned proton beams with high accuracy and throughput while minimizing biological uncertainties. We found that the relationship between cell kill, dose, and LET, is complex and non-unique. Measured biologic effects were substantially greater than in most previous reports, and non-linear surviving fraction response was observed even for the highest LET values. Extension of this approach could generate data needed to optimize proton therapy plans incorporating variable RBE. PMID:25984967

  11. Spatial mapping of the biologic effectiveness of scanned particle beams: towards biologically optimized particle therapy

    PubMed Central

    Guan, Fada; Bronk, Lawrence; Titt, Uwe; Lin, Steven H.; Mirkovic, Dragan; Kerr, Matthew D.; Zhu, X. Ronald; Dinh, Jeffrey; Sobieski, Mary; Stephan, Clifford; Peeler, Christopher R.; Taleei, Reza; Mohan, Radhe; Grosshans, David R.

    2015-01-01

    The physical properties of particles used in radiation therapy, such as protons, have been well characterized, and their dose distributions are superior to photon-based treatments. However, proton therapy may also have inherent biologic advantages that have not been capitalized on. Unlike photon beams, the linear energy transfer (LET) and hence biologic effectiveness of particle beams varies along the beam path. Selective placement of areas of high effectiveness could enhance tumor cell kill and simultaneously spare normal tissues. However, previous methods for mapping spatial variations in biologic effectiveness are time-consuming and often yield inconsistent results with large uncertainties. Thus the data needed to accurately model relative biological effectiveness to guide novel treatment planning approaches are limited. We used Monte Carlo modeling and high-content automated clonogenic survival assays to spatially map the biologic effectiveness of scanned proton beams with high accuracy and throughput while minimizing biological uncertainties. We found that the relationship between cell kill, dose, and LET, is complex and non-unique. Measured biologic effects were substantially greater than in most previous reports, and non-linear surviving fraction response was observed even for the highest LET values. Extension of this approach could generate data needed to optimize proton therapy plans incorporating variable RBE. PMID:25984967

  12. Atypical antipsychotic therapy and hyperlipidemia: a review.

    PubMed

    Koro, Carol E; Meyer, Jonathan M

    2005-01-01

    Ziprasidone (Geodon), risperidone (Risperdal), and aripiprazole (Abilify) appear to be associated with a relatively low risk for hyperlipidemia, whereas quetiapine (Seroquel), olanzapine (Zyprexa), and clozapine (Clozaril) are associated with a relatively high risk for hyperlipidemia. Possible underlying causes of lipid dysregulation include weight gain, dietary changes, and glucose intolerance. Given the multiple cardiovascular risk factors reported for patients with schizophrenia, great care must be exercised to minimize the additional risk for hyperlipidemia when choosing antipsychotic therapy. It is recommended that a lipid panel be obtained at baseline for all patients with schizophrenia and annually thereafter for patients taking relatively low-risk agents or quarterly thereafter for patients taking relatively high-risk agents. Patients with persistent dyslipidemia should be referred for lipid-lowering therapy or switched to a less lipid-enhancing antipsychotic agent. PMID:15869022

  13. Therapy gloves for patients with rheumatoid arthritis: a review

    PubMed Central

    Troynikov, Olga; Massy-Westropp, Nicola

    2014-01-01

    Rheumatoid arthritis is a chronic inflammatory disease that causes pain, joint stiffness and swelling leading to impaired hand function and difficulty with daily activities. Wearing therapy gloves has been recommended by occupational therapists as one of the alternative treatment methods for rheumatoid arthritis. This study aims to review the available literature on the effects of wearing therapy gloves on patients’ hand function and symptoms as well as to discuss the attributes of gloves that might influence the glove performance. An electronic databases search of MEDLINE, Physiotherapy Evidence Database, Occupational Therapy Systematic Evaluation of Evidence, Wiley Online Library, ScienceDirect and Cochrane Central Register of Controlled Trial was performed. Eight articles met the inclusion criteria, and covered seven clinical trials and one case study. Seven outcome measures were identified from the included studies and were then classified into two categories: hand function and hand symptoms. The hand symptoms such as pain, stiffness and swelling improve substantially when the therapy gloves are used. However, marginal or no improvement in hand function (with the exception of grip strength) linked to the use of therapy gloves is being reported. Further research is needed to quantify the effectiveness of therapy gloves, especially in improvement of hand function and in patients’ interest in wearing therapy gloves. Furthermore, future studies should include parameters which might influence therapy gloves’ performance, such as duration of trials, interface pressure generated by the gloves on the underlying skin and tissue, glove fit and construction, as well as thermophysiological comfort. PMID:25435925

  14. Nanodosimetry-Based Plan Optimization for Particle Therapy

    PubMed Central

    Casiraghi, Margherita; Schulte, Reinhard W.

    2015-01-01

    Treatment planning for particle therapy is currently an active field of research due uncertainty in how to modify physical dose in order to create a uniform biological dose response in the target. A novel treatment plan optimization strategy based on measurable nanodosimetric quantities rather than biophysical models is proposed in this work. Simplified proton and carbon treatment plans were simulated in a water phantom to investigate the optimization feasibility. Track structures of the mixed radiation field produced at different depths in the target volume were simulated with Geant4-DNA and nanodosimetric descriptors were calculated. The fluences of the treatment field pencil beams were optimized in order to create a mixed field with equal nanodosimetric descriptors at each of the multiple positions in spread-out particle Bragg peaks. For both proton and carbon ion plans, a uniform spatial distribution of nanodosimetric descriptors could be obtained by optimizing opposing-field but not single-field plans. The results obtained indicate that uniform nanodosimetrically weighted plans, which may also be radiobiologically uniform, can be obtained with this approach. Future investigations need to demonstrate that this approach is also feasible for more complicated beam arrangements and that it leads to biologically uniform response in tumor cells and tissues. PMID:26167202

  15. Electroconvulsive therapy in pregnancy - A review.

    PubMed

    Spodniaková, B; Halmo, M; Nosá?ová, P

    2015-10-01

    Most major psychiatric illnesses are resistant to psychotropic drugs that are approved for use during pregnancy. Maternal illness and related medications may have adverse impacts on the foetus. Electroconvulsive therapy (ECT) might be an effective and safe option for treating several psychiatric disorders in pregnant women. This study evaluates the use of ECT for treating major psychoses during pregnancy and presents an assessment of risks faced by both mother and foetus. Based on our analysis we present recommendations for safe and effective treatment of psychiatric diseases via ECT in pregnant women. PMID:25526509

  16. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Medical charged-particle radiation therapy system. 892.5050 Section 892.5050 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5050 Medical charged-particle radiation therapy system....

  17. TRAIL combinations: The new ‘trail’ for cancer therapy (Review)

    PubMed Central

    REFAAT, ALAA; ABD-RABOU, AHMED; REDA, ASMAA

    2014-01-01

    Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) therapy is anticipated to be one of the most effective cancer treatments. However, resistance to TRAIL therapy remains a challenge facing the development of anticancer strategies. To circumvent this problem, TRAIL combinations have been experimented with for over ten years to induce synergism or sensitize resistant cancer cells. By analyzing the signaling pathways triggered by these combinations, this review has defined a set of core targets for novel combinatorial treatments. The review suggests specific pathways to be targeted together with TRAIL for more efficient treatment, including cellular FLICE inhibitory protein and its downstream survival factors, the Bcl-2 family and other prominent targets. The suggested pathways provide new avenues for more effective TRAIL-based cancer therapy. PMID:24765133

  18. Spiritually Modified Cognitive Therapy: A Review of the Literature

    ERIC Educational Resources Information Center

    Hodge, David R.

    2006-01-01

    A paucity of research exists on the effectiveness of spiritual interventions, despite their wide use by practitioners and the acknowledged importance of evidence-based practice. To assist practitioners in their selection of spiritual interventions, the author reviewed research on the effectiveness of spiritually modified cognitive therapy. The…

  19. Complementary Spiritist Therapy: Systematic Review of Scientific Evidence

    PubMed Central

    Lucchetti, Giancarlo; Lucchetti, Alessandra L. Granero; Bassi, Rodrigo M.; Nobre, Marlene Rossi Severino

    2011-01-01

    Spiritism is the third most common religion in Brazil, and its therapies have been used by millions worldwide. These therapies are based on therapeutic resources including prayer, laying on of hands, fluidotherapy (magnetized water), charity/volunteering, spirit education/moral values, and disobsession (spirit release therapy). This paper presents a systematic review of the current literature on the relationship among health outcomes and 6 predictors: prayer, laying on of hands, magnetized/fluidic water, charity/volunteering, spirit education (virtuous life and positive affect), and spirit release therapy. All articles were analyzed according to inclusion/exclusion criteria, Newcastle-Ottawa and Jadad score. At present, there is moderate to strong evidence that volunteering and positive affect are linked to better health outcomes. Furthermore, laying on of hands, virtuous life, and praying for oneself also seem to be associated to positive findings. Nevertheless, there is a lack of studies on magnetized water and spirit release therapy. In summary, science is indirectly demonstrating that some of these therapies can be associated to better health outcomes and that other therapies have been overlooked or poorly investigated. Further studies in this field could contribute to the disciplines of Complementary and Alternative Medicine by investigating the relationship between body, mind, and soul/spirit. PMID:21687790

  20. Review-Epigenetic therapy for cancer.

    PubMed

    Saleem, Mohammad; Abbas, Khizar; Manan, Maria; Ijaz, Hira; Ahmed, Bilal; Ali, Muhammad; Hanif, Muhammad; Farooqi, Ammad Ahmad; Qadir, Muhammad Imran

    2015-05-01

    Epigenetics means the study of alterations in the genetic material that affect the phenotype but does not affect the genotype. Epigenetics cause alterations in cell properties, which are inherited; but it does not cause alterations in DNA sequence. Epigenetic mediated silencing of gene is of four types, which are DNA methylation, histone deacetylation, RNA associated silencing and Genomic imprinting. Other factors (environmental and xenobiotics) can also cause gene silencing but DNA methytlation and changes in histones of chromatin are two important changes, which are responsible for malignant diseases. Two groups of drugs are under development, which corrects the epigenetic alterations. These are histone deacetylation (HDAC) inhibitors and DNA methytransferase (DNMT) inhibitors. These drugs may be used in cancer because in cancer, hypermethylation of cancer suppressor gene causes gene silencing. Epigenetic therapy scope is likely to increase in future. PMID:26004710

  1. [Review of symptoms and therapy of paraphylias].

    PubMed

    Kórász, Krisztián; Koras, Réka; Simon, Lajos

    2007-01-01

    The authors review the historical main milestones in the legislative aspects of sexual deviances, from ancient times through age of enlightenment to present times, including the factors affecting the Hungarian public attitudes towards it. The evolution of nomenclature of sexual orientation disorders is also evaluated thoroughly, detailing the DSM-IV-TR classification and the attempts and difficulties to further develop the present classification system. The authors also review the difficulties of epidemiological studies and sum up the pioneer work of Alfred Kinsey. The etiology of paraphylias is summed up based on biological, psychodynamic and learning theory approaches. Finally, the pharmacological and psychotherapeutic interventions are evaluated considering also comorbidity, outer control and forensic psychiatric aspects. PMID:18445868

  2. Dose to normal tissues outside the radiation therapy patient's treated volume: a review of different radiation therapy techniques.

    PubMed

    Purdy, James A

    2008-11-01

    Radiation therapy treatment planning and delivery capabilities have changed dramatically since the introduction of three-dimensional treatment planning and are continuing to change relatively rapidly in response to the implementation of new advanced technologies. Three-dimensional conformal radiation therapy (3DCRT) is now firmly in place as the standard of practice in clinics around the world. Medical accelerator manufacturers have employed advanced computer technology to produce treatment planning/delivery systems capable of precise shaping of dose distributions via computer-controlled multileaf collimator (MLC) systems, by which the beam fluence is varied optimally to achieve the desired dose distribution. This mode of conformal therapy is referred to as intensity modulated radiation therapy (IMRT), and is capable of generating dose distributions (including concave isodose volumes) that closely conform the prescription dose to the target volume and/or avoid specific sensitive normal structures. The increasing use of IMRT has focused attention on the need to better account for the intra- and inter-fraction spatial uncertainties in the dose delivery process. This has helped spur the development of treatment machines with integrated planar and volumetric advanced imaging capabilities, providing a new treatment modality referred to as image-guided IMRT (IG-IMRT), or simply image-guided radiation therapy (IGRT). In addition, there is a growing interest in replacing x rays with protons because of the physical characteristics of the depth dose curve, which peaks at the end of particle range, and eventually with even heavier charged particles to take advantage of the greater density of energy deposition close to the Bragg peak and hence larger relative biological effectiveness (RBE). Three-dimensional CRT, IMRT and proton beam therapy all provide improved target coverage and lower doses to surrounding normal tissues as compared to the previously used two-dimensional radiation therapy techniques. However, this is achieved at the expense of a greater volume of normal tissue in the irradiated volume receiving some dose and a higher whole body dose (or peripheral dose) to distant normal tissues. The higher whole body dose is a result of the increased x-ray leakage radiation to the patient due to the longer beam-on times associated with IMRT, and also from neutron leakage radiation associated with high energy x-ray beams (>10 MV) and proton beams. Dose distributions for the various CRT techniques and the current status of available data for normal tissues, and whole body dose are reviewed. PMID:18849701

  3. Precise on-line position measurement for particle therapy

    NASA Astrophysics Data System (ADS)

    Actis, O.; Meer, D.; König, S.

    2014-12-01

    An on-line beam position monitoring and regular beam stability tests are of utmost importance for the Quality Assurance (QA) of the patient treatment at any particle therapy facility. The Gantry 2 at the Paul Scherrer Institute uses a strip ionization chamber for the on-line beam position verification. The design of the strip chamber placed in the beam in front of the patient allows for a small beam penumbra in order to achieve a high-quality lateral beam delivery. The position error of 1 mm in a lateral plane (plane perpendicular to the beam direction) can result in a dose inhomogeneity of more than 5%. Therefore the goal of Gantry 2 commissioning was to reach a sub-millimeter level of the reconstruction accuracy in order to bring a dose uncertainty to a level of 1%. In fact, we observed that for beams offered by Gantry 2 signal profiles in a lateral plane can be reconstructed with a precision of 0.1 mm. This is a necessary criterion to perform a reliable patient treatment. The front end electronics and the whole data processing sequence have been optimized for minimizing the dead time in between two consecutive spots to about 2 ms: the charge collection is performed in about 1 ms, read-out takes place in about 100?s while data verification and logging are completed in less than 1 ms.

  4. Brake wear particle emissions: a review.

    PubMed

    Grigoratos, Theodoros; Martini, Giorgio

    2015-02-01

    Traffic-related sources have been recognized as a significant contributor of particulate matter particularly within major cities. Exhaust and non-exhaust traffic-related sources are estimated to contribute almost equally to traffic-related PM10 emissions. Non-exhaust particles can be generated either from non-exhaust sources such as brake, tyre, clutch and road surface wear or already exist in the form of deposited material at the roadside and become resuspended due to traffic-induced turbulence. Among non-exhaust sources, brake wear can be a significant particulate matter (PM) contributor, particularly within areas with high traffic density and braking frequency. Studies mention that in urban environments, brake wear can contribute up to 55 % by mass to total non-exhaust traffic-related PM10 emissions and up to 21 % by mass to total traffic-related PM10 emissions, while in freeways, this contribution is lower due to lower braking frequency. As exhaust emissions control become stricter, relative contributions of non-exhaust sources-and therefore brake wear-to traffic-related emissions will become more significant and will raise discussions on possible regulatory needs. The aim of the present literature review study is to present the state-of-the-art of the different aspects regarding PM resulting from brake wear and provide all the necessary information in terms of importance, physicochemical characteristics, emission factors and possible health effects. PMID:25318420

  5. Mind-body Therapies for Menopausal Symptoms: A Systematic Review

    PubMed Central

    Innes, Kim E; Selfe, Terry Kit; Vishnu, Abhishek

    2010-01-01

    Objective To systematically review the peer-reviewed literature regarding the effects of self-administered mind-body therapies on menopausal symptoms. Methods To identify qualifying studies, we searched 10 scientific databases and scanned bibliographies of relevant review papers and all identified articles. The methodological quality of all studies was assessed systematically using predefined criteria. Results Twenty-one papers representing 18 clinical trials from 6 countries met our inclusion criteria, including 12 randomized controlled trials (N=719), 1 non-randomized controlled trial (N=58), and 5 uncontrolled trials (N=105). Interventions included yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low frequency sound-wave therapy. Eight of the nine studies of yoga, tai chi, and meditation-based programs reported improvement in overall menopausal and vasomotor symptoms; six of seven trials indicated improvement in mood and sleep with yoga-based programs, and four studies reported reduced musculoskeletal pain. Results from the remaining nine trials suggest that breath-based and other relaxation therapies also show promise for alleviating vasomotor and other menopausal symptoms, although intergroup findings were mixed. Most studies reviewed suffered methodological or other limitations, complicating interpretation of findings. Conclusions Collectively, findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy. Additional large, methodologically sound trials are needed to determine the effects of specific mind-body therapies on menopausal symptoms, examine long-term outcomes, and investigate underlying mechanisms. PMID:20167444

  6. Maggot therapy: a literature review of methods and patient experience.

    PubMed

    Menon, Jane

    Used in wound-bed preparation, larval therapy can be effective both clinically and financially, if used appropriately. In this article,the author reviews contemporary literature and key research on the benefits and challenges of using this therapy for wound care. The article focuses on debridement, as well as associated antimicrobial effects and psychological issues. Considerations and cautions that may affect clinical practice, such as pain management, peri-wound skin care, different methods of application and preparing the patient both physically and psychologically are also explored. PMID:22489341

  7. Immune therapy in autoimmune encephalitis: a systematic review.

    PubMed

    Nosadini, Margherita; Mohammad, Shekeeb S; Ramanathan, Sudarshini; Brilot, Fabienne; Dale, Russell C

    2015-12-01

    We have reviewed the literature of immune therapy in autoimmune encephalitis associated with antibodies to cell surface antigens including N-methyl-D-aspartate receptor (NMDAR), leucine-rich, glioma-inactivated protein-1 (LGI1), contactin-associated protein-2 (Caspr2), the ?-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), ?-aminobutyric acid-A receptor (GABAAR), ?-aminobutyric acid-B receptor (GABABR), Glycine R and other rarer antigens. Most studies are retrospective cohorts, and there are no randomised controlled trials. Most clinicians use first-line therapy (steroids, intravenous immunoglobulin, plasma exchange), and if severe or refractory, second-line therapy (rituximab, cyclophosphamide). When present, tumours should be removed. There are common therapeutic themes emerging. Firstly, patients given immune therapy do better and relapse less than patients given no treatment. Secondly, patients given early treatment do better. And thirdly, when patients fail first-line therapy, second-line therapy improves outcomes and reduces relapses. Given the retrospective uncontrolled data, the literature has inherent bias, including severity and reporting bias. PMID:26559389

  8. Outcome Studies on the Efficacy of Art Therapy: A Review of Findings

    ERIC Educational Resources Information Center

    Slayton, Sarah; D'Archer, Jeanne; Kaplan, Frances

    2010-01-01

    In response to a review by Reynolds, Nabors, and Quinlan (2000) of the art therapy literature prior to 1999, this review article identifies studies from 1999-2007 that measured outcomes of art therapy effectiveness with all ages of clinical and nonclinical populations. Although numerous studies blend art therapy with other modalities, this review

  9. [Psychological therapy of migraine: systematic review].

    PubMed

    Fritsche, G; Kröner-Herwig, B; Kropp, P; Niederberger, U; Haag, G

    2013-06-01

    This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. On average a reduction in migraine frequency of 35-45 % is achieved. The mean effect sizes (ES) of various biofeedback techniques are between 0.4 and 0.6. Cognitive-behavioral treatment is applied as a multimodal treatment and on average achieves an improvement in migraine activity by 39 % and an ES of 0.54. All behavioral procedures can be used in combination or as an alternative to drug prophylaxis with comparable success. A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications. PMID:23685993

  10. Zinc therapy in dermatology: a review.

    PubMed

    Gupta, Mrinal; Mahajan, Vikram K; Mehta, Karaninder S; Chauhan, Pushpinder S

    2014-01-01

    Zinc, both in elemental or in its salt forms, has been used as a therapeutic modality for centuries. Topical preparations like zinc oxide, calamine, or zinc pyrithione have been in use as photoprotecting, soothing agents or as active ingredient of antidandruff shampoos. Its use has expanded manifold over the years for a number of dermatological conditions including infections (leishmaniasis, warts), inflammatory dermatoses (acne vulgaris, rosacea), pigmentary disorders (melasma), and neoplasias (basal cell carcinoma). Although the role of oral zinc is well-established in human zinc deficiency syndromes including acrodermatitis enteropathica, it is only in recent years that importance of zinc as a micronutrient essential for infant growth and development has been recognized. The paper reviews various dermatological uses of zinc. PMID:25120566

  11. Zinc Therapy in Dermatology: A Review

    PubMed Central

    Mahajan, Vikram K.; Mehta, Karaninder S.; Chauhan, Pushpinder S.

    2014-01-01

    Zinc, both in elemental or in its salt forms, has been used as a therapeutic modality for centuries. Topical preparations like zinc oxide, calamine, or zinc pyrithione have been in use as photoprotecting, soothing agents or as active ingredient of antidandruff shampoos. Its use has expanded manifold over the years for a number of dermatological conditions including infections (leishmaniasis, warts), inflammatory dermatoses (acne vulgaris, rosacea), pigmentary disorders (melasma), and neoplasias (basal cell carcinoma). Although the role of oral zinc is well-established in human zinc deficiency syndromes including acrodermatitis enteropathica, it is only in recent years that importance of zinc as a micronutrient essential for infant growth and development has been recognized. The paper reviews various dermatological uses of zinc. PMID:25120566

  12. review The American Society of Gene & Cell Therapy Molecular Therapy vol. 19 no. 8, 14071415 aug. 2011 1407

    E-print Network

    review© The American Society of Gene & Cell Therapy Molecular Therapy vol. 19 no. 8, 1407­1415 aug. 2011 1407 IntroductIon Gene therapy has shown increasing promise in clinical trials for disorders in the development of gene delivery systems must continue to build upon the recent successes in the field and further

  13. Bioethical conflicts of gene therapy: a brief critical review.

    PubMed

    Freire, José Ednésio da Cruz; Medeiros, Suelen Carneiro de; Lopes Neto, Antônio Viana; Monteiro Júnior, José Edvar; Sousa, Antônio Juscelino Sudário; Rocha, Antônio José; Menezes, Léa Maria Bezerra de

    2014-01-01

    Methods and techniques employed in gene therapy are reviewed in parallel with pertinent ethical conflicts. Clinical interventions based on gene therapy techniques preferentially use vectors for the transportation of therapeutic genes, however little is known about the potential risks and damages to the patient. Thus, attending carefully to the clinical complications arising as well as to security is essential. Despite the scientific and technological advances, there are still many uncertainties about the side effects of gene therapy. Moreover, there is a need, above all, to understand the principles of bioethics as both science and ethics, in accordance with its socioecological responsibility, in order to prioritize the health and welfare of man and nature, using properly natural resources and technology. Therefore, it is hard to determine objective results and to which extent the insertion of genes can affect the organism, as well as the ethical implication. PMID:25650850

  14. Review of Tumor Dormancy Therapy Using Traditional Oriental Herbal Medicine

    PubMed Central

    Lee, Jong-Ho; Koung, Fan-Pei; Cho, Chong-Kwan; Lee, Yeon-Weol; Yoo, Hwa-Seung

    2013-01-01

    Objective: Standard cancer therapy prolongs survival, but can be detrimental to the quality of life, compromise the immune system, and leave residual disease that can cause recurrence years or decades in the future. Tumor dormancy therapy is a novel therapeutic approach that may improve these shortcomings, promote quality of life, and prolong survival. The aim of this study was to analyze studies on dormancy therapy, especially studies using traditional Oriental herbal medicine, so as to evaluate the efficacy of dormancy therapy with traditional oriental herbal medicine. Methods: We conducted a systematic literature review using Scientific and Technical Information Integration Services (NDSL), PubMed, and RISS. We searched for clinical reports, papers, and books related to tumor metastasis, recurrence, immunotherapy, tumor dormancy, and traditional oriental herbal medicine with anticancer effects. Seventy-nine (79) experimental and clinical articles in both Korean and English were reviewed. This study was conducted from March 1, 2012 to May 31, 2012. Results: This approach, Tumor dormancy therapy, rather than seeking to remove the tumor, includes combination of low-dose chemotherapy, immunotherapy, immunosurveillance, and other methods to stabilize tumor growth and to enhance the host is immunity against disseminated tumor cells and thus to manage cancer as a chronic disease while maintaining quality of life. In particular, integrative use of Oriental herbal medicine has been shown to induce or maintain tumor dormancy, increase the effectiveness of conventional chemotherapy, improve quality of life, and prolong survival. Conclusion: Tumor dormancy therapy is a promising novel therapeutic approach that may be especially effective with Oriental herbal medicine. Further research is needed to determine its potential mechanisms and therapeutic applications. PMID:25780657

  15. Heuristic optimization of the scanning path of particle therapy beams

    SciTech Connect

    Pardo, J.; Donetti, M.; Bourhaleb, F.; Ansarinejad, A.; Attili, A.; Cirio, R.; Garella, M. A.; Giordanengo, S.; Givehchi, N.; La Rosa, A.; Marchetto, F.; Monaco, V.; Pecka, A.; Peroni, C.; Russo, G.; Sacchi, R.

    2009-06-15

    Quasidiscrete scanning is a delivery strategy for proton and ion beam therapy in which the beam is turned off when a slice is finished and a new energy must be set but not during the scanning between consecutive spots. Different scanning paths lead to different dose distributions due to the contribution of the unintended transit dose between spots. In this work an algorithm to optimize the scanning path for quasidiscrete scanned beams is presented. The classical simulated annealing algorithm is used. It is a heuristic algorithm frequently used in combinatorial optimization problems, which allows us to obtain nearly optimal solutions in acceptable running times. A study focused on the best choice of operational parameters on which the algorithm performance depends is presented. The convergence properties of the algorithm have been further improved by using the next-neighbor algorithm to generate the starting paths. Scanning paths for two clinical treatments have been optimized. The optimized paths are found to be shorter than the back-and-forth, top-to-bottom (zigzag) paths generally provided by the treatment planning systems. The gamma method has been applied to quantify the improvement achieved on the dose distribution. Results show a reduction of the transit dose when the optimized paths are used. The benefit is clear especially when the fluence per spot is low, as in the case of repainting. The minimization of the transit dose can potentially allow the use of higher beam intensities, thus decreasing the treatment time. The algorithm implemented for this work can optimize efficiently the scanning path of quasidiscrete scanned particle beams. Optimized scanning paths decrease the transit dose and lead to better dose distributions.

  16. Construction and characterization of virus-like particles: a review.

    PubMed

    Zeltins, Andris

    2013-01-01

    Over the last three decades, virus-like particles (VLPs) have evolved to become a widely accepted technology, especially in the field of vaccinology. In fact, some VLP-based vaccines are currently used as commercial medical products, and other VLP-based products are at different stages of clinical study. Several remarkable advantages have been achieved in the development of VLPs as gene therapy tools and new nanomaterials. The analysis of published data reveals that at least 110 VLPs have been constructed from viruses belonging to 35 different families. This review therefore discusses the main principles in the cloning of viral structural genes, the relevant host systems and the purification procedures that have been developed. In addition, the methods that are used to characterize the structural integrity, stability, and components, including the encapsidated nucleic acids, of newly synthesized VLPs are analyzed. Moreover, some of the modifications that are required to construct VLP-based carriers of viral origin with defined properties are discussed, and examples are provided. PMID:23001867

  17. TOPICAL REVIEW: The physics, biophysics and technology of photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Wilson, Brian C.; Patterson, Michael S.

    2008-05-01

    Photodynamic therapy (PDT) uses light-activated drugs to treat diseases ranging from cancer to age-related macular degeneration and antibiotic-resistant infections. This paper reviews the current status of PDT with an emphasis on the contributions of physics, biophysics and technology, and the challenges remaining in the optimization and adoption of this treatment modality. A theme of the review is the complexity of PDT dosimetry due to the dynamic nature of the three essential components—light, photosensitizer and oxygen. Considerable progress has been made in understanding the problem and in developing instruments to measure all three, so that optimization of individual PDT treatments is becoming a feasible target. The final section of the review introduces some new frontiers of research including low dose rate (metronomic) PDT, two-photon PDT, activatable PDT molecular beacons and nanoparticle-based PDT.

  18. TOPICAL REVIEW: Stem cells engineering for cell-based therapy

    NASA Astrophysics Data System (ADS)

    Taupin, Philippe

    2007-09-01

    Stem cells carry the promise to cure a broad range of diseases and injuries, from diabetes, heart and muscular diseases, to neurological diseases, disorders and injuries. Significant progresses have been made in stem cell research over the past decade; the derivation of embryonic stem cells (ESCs) from human tissues, the development of cloning technology by somatic cell nuclear transfer (SCNT) and the confirmation that neurogenesis occurs in the adult mammalian brain and that neural stem cells (NSCs) reside in the adult central nervous system (CNS), including that of humans. Despite these advances, there may be decades before stem cell research will translate into therapy. Stem cell research is also subject to ethical and political debates, controversies and legislation, which slow its progress. Cell engineering has proven successful in bringing genetic research to therapy. In this review, I will review, in two examples, how investigators are applying cell engineering to stem cell biology to circumvent stem cells' ethical and political constraints and bolster stem cell research and therapy.

  19. Immunosuppressive therapy in acute myocarditis: an 18 year systematic review

    PubMed Central

    Hia, C; Yip, W; Tai, B; Quek, S

    2004-01-01

    Background: Immunosuppressive therapy is reportedly ineffective in adults with acute myocarditis. Aims: To systematically review the impact of immunosuppressive therapy on the outcome of acute myocarditis in children. Methods: A literature search for articles published from 1984 to 2003 was conducted with the following keywords: myocarditis, dilated cardiomyopathy, and immunosuppression. The relevant studies were systematically reviewed and comparison of treatment effect was made by calculating the odds ratio (OR) and confidence interval (CI) using the exact method based on the exact discrete reference distribution. Results: Of the 1470 articles found, only nine studies were eligible. The odds for improvement with immunosuppression was between 4.33 (95% CI 0.52 to 52.23) and 2.7 (95% CI 0.59 to 14.21). Addition of a second immunosuppressive agent to prednisolone only proved effective in one randomised controlled trial (OR 0.09, 95% CI 0.01 to 0.52). Heterogeneity of these studies precluded pooled odds ratio. Conclusion: Current data suggest that immunosuppressive therapy does not significantly improve outcomes in children with acute myocarditis and there is insufficient evidence for its routine use. However, statistical power to detect a significant difference in the treatment effect may be limited because of the small number of subjects. This, together with problems of diagnosis, varying treatment practices, and a relative lack of evidence based guidelines would support efforts for a large multicentre, randomised controlled trial to better define the role of immunosuppression in acute myocarditis. PMID:15155409

  20. Music Therapy with Children: A Review of Clinical Utility and Application to Special Populations.

    ERIC Educational Resources Information Center

    Yeaw, John David Andrew

    This paper reviews the effectiveness of music therapy in treating children with psychiatric and developmental problems. The clinical utility of music therapy is first evaluated by examining the foundational effects of music on affect and behavior. Next, the two broad approaches to music therapy, active and passive music therapy, are discussed.…

  1. Vitamin Therapy and Children with Down's Syndrome: A Review of Research.

    ERIC Educational Resources Information Center

    Pruess, James B.; And Others

    1989-01-01

    Following a brief outline of vitamin therapy's effects on schizophrenia and learning disabilities, research is reviewed on vitamin therapy for children with Down's Syndrome, concluding with a discussion of critical responses to research endorsing vitamin therapy. It is concluded that vitamin therapy contributes nothing to the development of…

  2. Behavioral Therapies for Management of Premature Ejaculation: A Systematic Review

    PubMed Central

    Cooper, Katy; Martyn-St James, Marrissa; Kaltenthaler, Eva; Dickinson, Kath; Cantrell, Anna; Wylie, Kevan; Frodsham, Leila; Hood, Catherine

    2015-01-01

    Introduction Premature ejaculation (PE) is defined by short ejaculatory latency and inability to delay ejaculation causing distress. Management may involve behavioral and/or pharmacological approaches. Aim To systematically review the randomized controlled trial (RCT) evidence for behavioral therapies in the management of PE. Methods Nine databases including MEDLINE were searched up to August 2014. Included RCTs compared behavioral therapy against waitlist control or another therapy, or behavioral plus drug therapy against drug treatment alone. [Correction added on 10 September 2015, after first online publication: Search period has been amended from August 2013 to August 2014.] Main Outcome Measure Intravaginal ejaculatory latency time (IELT), sexual satisfaction, ejaculatory control, and anxiety and adverse effects. Results Ten RCTs (521 participants) were included. Overall risk of bias was unclear. All studies assessed physical techniques, including squeeze and stop-start, sensate focus, stimulation device, and pelvic floor rehabilitation. Only one RCT included a psychotherapeutic approach (combined with stop-start and drug treatment). Four trials compared behavioral therapies against waitlist control, of which two (involving squeeze, stop-start, and sensate focus) reported IELT differences of 7–9 minutes, whereas two (web-based sensate focus, stimulation device) reported no difference in ejaculatory latency posttreatment. For other outcomes (sexual satisfaction, desire, and self-confidence), some waitlist comparisons significantly favored behavioral therapy, whereas others were not significant. Three trials favored combined behavioral and drug treatment over drug treatment alone, with small but significant differences in IELT (0.5–1 minute) and significantly better results on other outcomes (sexual satisfaction, ejaculatory control, and anxiety). Direct comparisons of behavioral therapy vs. drug treatment gave mixed results, mostly either favoring drug treatment or showing no significant difference. No adverse effects were reported, though safety data were limited. Conclusions There is limited evidence that physical behavioral techniques for PE improve IELT and other outcomes over waitlist and that behavioral therapies combined with drug treatments give better outcomes than drug treatments alone. Further RCTs are required to assess psychotherapeutic approaches to PE. PMID:26468381

  3. Antibiotic lock therapy: review of technique and logistical challenges

    PubMed Central

    Justo, Julie Ann; Bookstaver, P Brandon

    2014-01-01

    Antibiotic lock therapy (ALT) for the prevention and treatment of catheter-related bloodstream infections is a simple strategy in theory, yet its real-world application may be delayed or avoided due to technical questions and/or logistical challenges. This review focuses on these latter aspects of ALT, including preparation information for a variety of antibiotic lock solutions (ie, aminoglycosides, beta-lactams, fluoroquinolones, folate antagonists, glycopeptides, glycylcyclines, lipopeptides, oxazolidinones, polymyxins, and tetracyclines) and common clinical issues surrounding ALT administration. Detailed data regarding concentrations, additives, stability/compatibility, and dwell times are summarized. Logistical challenges such as lock preparation procedures, use of additives (eg, heparin, citrate, or ethylenediaminetetraacetic acid), timing of initiation and therapy duration, optimal dwell time and catheter accessibility, and risks of ALT are also described. Development of local protocols is recommended in order to avoid these potential barriers and encourage utilization of ALT where appropriate. PMID:25548523

  4. Acanthamoeba encephalitis: A Case Report and Review of Therapy

    PubMed Central

    Zamora, A.; Henderson, H.; Swiatlo, E.

    2014-01-01

    Background: Acanthamoeba is a rare cause of encephalitis yet is associated with high mortality. Treatment protocols vary greatly and generally include combination therapy across a wide spectrum of antiinfective classes. Case Description: A 63-year-old male who underwent renal transplantation presented 6 months after transplantation with depressed level of consciousness. Imaging of the head with computerized tomography showed an enhancing lesion suspicious for brain abscess. Biopsy of the lesion showed Acanthamoeba cysts. The patient was treated with sulfadiazine, fluconazole, flucytosine, azithromycin, and miltefosine but without success. We review recently published cases of Acanthamoeba encephalitis with an emphasis on treatment protocols and outcomes. Conclusion: Free-living protozoans such as Acanthamoeba are ubiquitous in the environment and should be suspected in immunosuppressed persons who present with central nervous system findings and brain abscess. Biopsy is critical to establish the etiology so that appropriate combination therapy can be deployed. PMID:24991471

  5. Using antimicrobial adjuvant therapy in cancer treatment: a review

    PubMed Central

    2012-01-01

    Recent clinical and pre-clinical data demonstrate that adjuvant antimicrobial therapy is beneficial in cancer treatment. There could be several reasons for this effect, which include treating cancer associated bacteria and viruses, prophylaxis of post-chemotherapy infections due to immunosuppression, and antiproliferative effect of certain antimicrobials. Targeting cancer associated viruses and bacteria with antimicrobial agents is currently used for gastric, cervical, hematopoietic, liver and brain cancer. However this treatment is effective only in combination with conventional therapies. Antimicrobials can also have a direct antiproliferative and cytotoxic effect, and can cause apoptosis. Moreover, some antimicrobials are known to be helpful in overcoming side effects of drugs commonly used in cancer treatment. Chemotherapy related bacteremia and neutropenia can be overcome by the appropriately timed use of antimicrobials. This review summarizes the data on the effects of antivirals and antibiotics on cancer treatment and describes their mechanisms. PMID:23164412

  6. An umbrella review: Corticosteroid therapy for adults with acute asthma

    PubMed Central

    Krishnan, Jerry A.; Davis, Steven Q.; Naureckas, Edward T.; Gibson, Peter; Rowe, Brian H.

    2009-01-01

    The objective of this ‘umbrella’ review is to synthesize the evidence and provide clinicians a single report which summarizes the state of knowledge regarding the use of corticosteroids in adults with acute asthma. Systematic reviews in the Cochrane Library and additional clinical trials published in English from 1966 to 2007 in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL and references from bibliographies of pertinent articles were reviewed. Results indicate that the evidence base is frequently limited to small, single-center studies. Findings suggest that therapy with systemic corticosteroids accelerates resolution of acute asthma and reduces the risk of relapse. There is no evidence that corticosteroid doses higher than standard doses (prednisone 50–100 mg equivalent) are beneficial. Oral and intravenous corticosteroids, as well as intramuscular and oral corticosteroid regimens appear to be similarly effective. A non-tapered 5–10 day course of corticosteroid therapy appears to be sufficient for most discharged patients. Combinations of oral and inhaled corticosteroids on emergency department/hospital discharge may minimize the risk of relapse. PMID:19854321

  7. Current Therapy of Acquired Ocular Toxoplasmosis: A Review.

    PubMed

    Cerqueira Lima, Guilherme Sturzeneker; Saraiva, Patricia Grativol Costa; Saraiva, Fábio Petersen

    2015-11-01

    Caused by the parasite Toxoplasma gondii, ocular toxoplasmosis (OT) is the most common form of posterior infectious uveitis. Combined antiparasitic therapy is the standard treatment for OT, but several other schemes have been proposed. The purpose of the present study was to review the literature on the treatment of OT and provide ophthalmologists with up-to-date information to help reduce OT-related visual morbidity. In conclusion, no ideal treatment scheme was identified; currently prescribed therapeutic schemes yield statistically similar functional outcomes. PMID:26226199

  8. Light-based therapy on wound healing?:?a review

    NASA Astrophysics Data System (ADS)

    Pik Suan, Lau; Bidin, Noriah; Cherng, Chong Jia; Hamid, Asmah

    2014-08-01

    Wound healing is a complex matrix and overlapping process. In order to accelerate the healing process and minimize bacterial infection, light-based therapy was applied to stimulate bio-reaction to improve healing. The aim of this paper is to review the effects induced by light source (laser and incoherent light like LED) on different biological targets. The light-based therapy techniques were categorized according to the wavelength, energy density, type of irradiance and activity of tissues in the healing process. Out of 80 cases, 77% were animal studies, 5% were human studies and 18% were cell studies. Around 75% of light-based therapy has an advantage on tissue interaction and 25% has no effect or inhibition on the healing process. The appropriate dose appears to be between 1 and 5?J cm-2. At shorter wavelength, photobiostimulation would be effective with a high frequently administrated low-energy dose. On the other hand, for longer wavelength it is the reverse, i.e., more effective with a low frequent treated schedule and a high-energy dose.

  9. ROLE OF PARTICLE HYGROSCOPICITY IN AEROSOL THERAPY AND INHALATION TOXICOLOGY

    EPA Science Inventory

    The extrathoracic compartment of the human respiratory tract (i.e., the naso- and oropharyngeal regions) effectively conditions inhaled air by warming and humidifying processes even in extreme ambient environments. When airborne particles are inhaled, the effectiveness of interac...

  10. Estrogen therapy and cognition: a review of the cholinergic hypothesis.

    PubMed

    Gibbs, Robert B

    2010-04-01

    The pros and cons of estrogen therapy for use in postmenopausal women continue to be a major topic of debate in women's health. Much of this debate focuses on the potential benefits vs. harm of estrogen therapy on the brain and the risks for cognitive impairment associated with aging and Alzheimer's disease. Many animal and human studies suggest that estrogens can have significant beneficial effects on brain aging and cognition and reduce the risk of Alzheimer's-related dementia; however, others disagree. Important discoveries have been made, and hypotheses have emerged that may explain some of the inconsistencies. This review focuses on the cholinergic hypothesis, specifically on evidence that beneficial effects of estrogens on brain aging and cognition are related to interactions with cholinergic projections emanating from the basal forebrain. These cholinergic projections play an important role in learning and attentional processes, and their function is known to decline with advanced age and in association with Alzheimer's disease. Evidence suggests that many of the effects of estrogens on neuronal plasticity and function and cognitive performance are related to or rely upon interactions with these cholinergic projections; however, studies also suggest that the effectiveness of estrogen therapy decreases with age and time after loss of ovarian function. We propose a model in which deficits in basal forebrain cholinergic function contribute to age-related changes in the response to estrogen therapy. Based on this model, we propose that cholinergic-enhancing drugs, used in combination with an appropriate estrogen-containing drug regimen, may be a viable therapeutic strategy for use in older postmenopausal women with early evidence of mild cognitive decline. PMID:20019127

  11. Estrogen Therapy and Cognition: A Review of the Cholinergic Hypothesis

    PubMed Central

    Gibbs, Robert B.

    2010-01-01

    The pros and cons of estrogen therapy for use in postmenopausal women continue to be a major topic of debate in women’s health. Much of this debate focuses on the potential benefits vs. harm of estrogen therapy on the brain and the risks for cognitive impairment associated with aging and Alzheimer’s disease. Many animal and human studies suggest that estrogens can have significant beneficial effects on brain aging and cognition and reduce the risk of Alzheimer’s-related dementia; however, others disagree. Important discoveries have been made, and hypotheses have emerged that may explain some of the inconsistencies. This review focuses on the cholinergic hypothesis, specifically on evidence that beneficial effects of estrogens on brain aging and cognition are related to interactions with cholinergic projections emanating from the basal forebrain. These cholinergic projections play an important role in learning and attentional processes, and their function is known to decline with advanced age and in association with Alzheimer’s disease. Evidence suggests that many of the effects of estrogens on neuronal plasticity and function and cognitive performance are related to or rely upon interactions with these cholinergic projections; however, studies also suggest that the effectiveness of estrogen therapy decreases with age and time after loss of ovarian function. We propose a model in which deficits in basal forebrain cholinergic function contribute to age-related changes in the response to estrogen therapy. Based on this model, we propose that cholinergic-enhancing drugs, used in combination with an appropriate estrogen-containing drug regimen, may be a viable therapeutic strategy for use in older postmenopausal women with early evidence of mild cognitive decline. PMID:20019127

  12. Immersion liquid techniques in solid particle characterization: A review.

    PubMed

    Niskanen, Ilpo; Hibino, Kenichi; Räty, Jukka

    2016-03-01

    Chemical, physical and optical properties of small solid particles are widely utilized in our everyday merchandises. For example, tailored particles embedded in paper or cosmetics improve the visual appearance of the products substantially. As a consequence of the small size of particles, one particle characterization tool is a microscope. It may provide e.g. the particle size, shape and the refractive index. The determination of the refractive index, using the microscope, typically exploited the so-called immersion liquid method. In this review, we provide an overview of non-imaging immersion matching techniques including immersion liquid set, the temperature, the wavelength, the double variation and the liquid evaporation methods. The basic features, benefits and limitations of each technique have been described followed by examples of potential applications in a quality monitoring of particle suspensions and colloids in industry. PMID:26717835

  13. Heavy charged particle radiobiology: using enhanced biological effectiveness and improved beam focusing to advance cancer therapy.

    PubMed

    Allen, Christopher; Borak, Thomas B; Tsujii, Hirohiko; Nickoloff, Jac A

    2011-06-01

    Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and ?-rays, are the most widely used type of ionizing radiation in radiobiology experiments, and in radiation cancer therapy. Charged particles, including protons and carbon ions, are seeing increased use as an alternative therapeutic modality. Although the facilities needed to produce high energy charged particle beams are more costly than photon facilities, particle therapy has shown improved cancer survival rates, reflecting more highly focused dose distributions and more severe DNA damage to tumor cells. Despite early successes of charged particle radiotherapy, there is room for further improvement, and much remains to be learned about normal and cancer cell responses to charged particle radiation. PMID:21376738

  14. Heavy Charged Particle Radiobiology: Using Enhanced Biological Effectiveness and Improved Beam Focusing to Advance Cancer Therapy

    PubMed Central

    Allen, Christopher; Borak, Thomas B.; Tsujii, Hirohiko; Nickoloff, Jac A.

    2011-01-01

    Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and ?-rays, are the most widely used type of ionizing radiation in radiobiology experiments, and in radiation cancer therapy. Charged particles, including protons and carbon ions, are seeing increased use as an alternative therapeutic modality. Although the facilities needed to produce high energy charged particle beams are more costly than photon facilities, particle therapy has shown improved cancer survival rates, reflecting more highly focused dose distributions and more severe DNA damage to tumor cells. Despite early successes of charged particle radiotherapy, there is room for further improvement, and much remains to be learned about normal and cancer cell responses to charged particle radiation. PMID:21376738

  15. Static Magnetic Field Therapy: A Critical Review of Treatment Parameters

    PubMed Central

    Wahbeh, Helané; Harling, Noelle; Connelly, Erin; Schiffke, Heather C.; Forsten, Cora; Gregory, William L.; Markov, Marko S.; Souder, James J.; Elmer, Patricia; King, Valerie

    2009-01-01

    Static magnetic field (SMF) therapy, applied via a permanent magnet attached to the skin, is used by people worldwide for self-care. Despite a lack of established SMF dosage and treatment regimens, multiple studies are conducted to evaluate SMF therapy effectiveness. Our objectives in conducting this review are to:(i) summarize SMF research conducted in humans; (ii) critically evaluate reporting quality of SMF dosages and treatment parameters and (iii) propose a set of criteria for reporting SMF treatment parameters in future clinical trials. We searched 27 electronic databases and reference lists. Only English language human studies were included. Excluded were studies of electromagnetic fields, transcranial magnetic stimulation, magnets placed on acupuncture points, animal studies, abstracts, posters and editorials. Data were extracted on clinical indication, study design and 10 essential SMF parameters. Three reviewers assessed quality of reporting and calculated a quality assessment score for each of the 10 treatment parameters. Fifty-six studies were reviewed, 42 conducted in patient populations and 14 in healthy volunteers. The SMF treatment parameters most often and most completely described were site of application, magnet support device and frequency and duration of application. Least often and least completely described were characteristics of the SMF: magnet dimensions, measured field strength and estimated distance of the magnet from the target tissue. Thirty-four (61%) of studies failed to provide enough detail about SMF dosage to permit protocol replication by other investigators. Our findings highlight the need to optimize SMF dosing parameters for individual clinical conditions before proceeding to a full-scale clinical trial. PMID:18955243

  16. Implications of technology in music therapy practice and research for music therapy education: a review of literature.

    PubMed

    Crowe, Barbara J; Rio, Robin

    2004-01-01

    This article reviews the use of technology in music therapy practice and research for the purpose of providing music therapy educators and clinicians with specific and accurate accounts of the types and benefits of technology being used in various settings. Additionally, this knowledge will help universities comply with National Association of Schools of Music requirements and help to standardize the education and training of music therapists in this rapidly changing area. Information was gathered through a literature review of music therapy and related professional journals and a wide variety of books and personal communications. More data were gathered in a survey requesting information on current use of technology in education and practice. This solicitation was sent to all American Music Therapy Association approved universities and clinical training directors. Technology applications in music therapy are organized according to the following categories: (a) adapted musical instruments, (b) recording technology, (c) electric/electronic musical instruments, (d) computer applications, (e) medical technology, (f) assistive technology for the disabled, and (g) technology-based music/sound healing practices. The literature reviewed covers 177 books and articles from a span of almost 40 years. Recommendations are made for incorporating technology into music therapy course work and for review and revision of AMTA competencies. The need for an all-encompassing clinical survey of the use of technology in current music therapy practice is also identified. PMID:15762835

  17. Emory Researchers Publish Review on Targeting Protein-Protein Interactions for Cancer Therapy

    Cancer.gov

    Published on Office of Cancer Genomics (http://ocg.cancer.gov) Home > Emory Researchers Publish Review on Targeting Protein-Protein Interactions for Cancer Therapy Emory Researchers Publish Review on Targeting Protein-Protein Interactions for Cancer

  18. Emory Researchers Publish Review on Targeting Protein-Protein Interactions for Cancer Therapy

    Cancer.gov

    Published on Office of Cancer Genomics (https://ocg.cancer.gov) Home > Emory Researchers Publish Review on Targeting Protein-Protein Interactions for Cancer Therapy Emory Researchers Publish Review on Targeting Protein-Protein Interactions for Cancer

  19. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

    PubMed Central

    Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

    2015-01-01

    Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications. PMID:26636968

  20. A REVIEW OF ANTI-HYPERTENSION THERAPIES IN DIABETIC PATIENTS

    PubMed Central

    Ogochukwu, Adibe Maxwell; Victoria, Ukwe Chinwe

    2010-01-01

    The objective of this study was to review published articles on the issues surrounding tight blood pressure control in hypertensive diabetics. Relevant medical subject headings (MeSH) terms and keywords to review scientific literatures were developed. These MeSH terms were used to generate MEDLINE searches that focused on English-language, peer-reviewed scientific literature. In reviewing the exceptionally large body of research literature in anti-hypertension therapies in diabetic patients , the review focused on outcomes of importance to patients and effects of sufficient magnitude to warrant changes in medical practice (“patient oriented evidence that matters” [POEMs]). Patient-oriented outcomes include not only mortality but also other outcomes that affect patients’ lives and well-being. Studies of physiological end points (diseaseoriented evidence [DOEs]) were used to address questions where POEMs were not available Treatment of hypertension in diabetic patients provides dramatic beneficial outcomes. Target diastolic BP of < 80 mmHg appears optimal; and systolic targets of 130 mmHg or less are also reasonable. Studies that compare drug classes do not suggest obviously superior agents. However, it is reasonable to conclude that ACEIs, thiazide diuretics and angiotension II receptor blockers may be the preferred first-line agents for treatment of hypertension in diabetes. ACEIs, ARBs and low dose thiazide diuretics may be the first line treatments although other agents are usually necessary and goals may not be achieved even with three or four agents. Aggressive blood pressure control may be the most important factor in preventing adverse outcomes in hypertensive patients with diabetes PMID:24825981

  1. The Outcomes of Manipulation or Mobilization Therapy Compared with Physical Therapy or Exercise for Neck Pain: A Systematic Review

    PubMed Central

    Schroeder, Josh; Kaplan, Leon; Fischer, Dena J.; Skelly, Andrea C.

    2013-01-01

    Study Design?Systematic review. Study Rationale?Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures are becoming an accepted treatment for neck pain. However, data on the effectiveness of these treatments have not been summarized. Objective?To compare manipulation or mobilization of the cervical spine to physical therapy or exercise for symptom improvement in patients with neck pain. Methods?A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database, and bibliographies of key articles, which compared spinal manipulation or mobilization therapy with physical therapy or exercise in patients with neck pain. Articles were included based on predetermined criteria and were appraised using a predefined quality rating scheme. Results?From 197 citations, 7 articles met all inclusion and exclusion criteria. There were no differences in pain improvement when comparing spinal manipulation to exercise, and there were inconsistent reports of pain improvement in subjects who underwent mobilization therapy versus physical therapy. No disability improvement was reported between treatment groups in studies of acute or chronic neck pain patients. No functional improvement was found with manipulation therapy compared with exercise treatment or mobilization therapy compared with physical therapy groups in patients with acute pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared to exercise treatment, results for short-term functional improvement were inconsistent. Conclusion?The data available suggest that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain. This systematic review is limited by the variability of treatment interventions and lack of standardized outcomes to assess treatment benefit. PMID:24436697

  2. Charged Particle Therapy Steps Into the Clinical Environment

    NASA Astrophysics Data System (ADS)

    Haberer, Th.

    Beams of heavy charged particles like protons or carbon ions represent the ideal tool for the treatment of deep-seated, inoperable and radioresistant tumors. For more than 4 decades research with beams of charged particles has been performed. In total more than 40000 patients have been treated, mostly using protons being delivered by accelerators that were designed for basic research centers. In Berkeley, USA heavier particles like helium or neon ions were used to conduct clinical trials until 1992. Based on that somewhat limited technological standard and triggered by the promising results from Berkeley the first dedicated charged particle facilities were constructed. In order to maximally exploit the advantageous physical and radiobiological characteristics of these beams enormous effort was put into developing dynamic beam delivery techniques and tailoring the capabilities of the accelerators, the planning systems and the quality assurance procedures and equipment to the requirements resulting from these new treatment modalities. Active beam delivery systems integrated in rotating gantries, if necessary, will allow the production of superior dose distributions that precisely follow the medical prescription. The technological progress being made during the last 10 years defines the state of the art of the upcoming next-generation facilities for the clinical environment in Europe and Japan.

  3. Nonverbal Communication, Music Therapy, and Autism: A Review of Literature and Case Example

    ERIC Educational Resources Information Center

    Silverman, Michael J.

    2008-01-01

    This article presents a review of nonverbal literature relating to therapy, music, autism, and music therapy. Included is a case study of a woman with autism who was nonverbal. The case highlights and analyzes behaviors contextually. Interpretations of communication through the music therapy, musical interactions, and the rapport that developed…

  4. Do Video Reviews of Therapy Sessions Help People with Mild Intellectual Disabilities Describe Their Perceptions of Cognitive Behaviour Therapy?

    ERIC Educational Resources Information Center

    Burford, B.; Jahoda, A.

    2012-01-01

    Background: This study examined the potential of a retrospective video reviewing process [Burford Reviewing Process (BRP)] for enabling people with intellectual disabilities to describe their experiences of cognitive behaviour therapy (CBT). It is the first time that the BRP, described in this paper, has been used with people with intellectual…

  5. A Review on Vital Pulp Therapy in Primary Teeth

    PubMed Central

    Parisay, Iman; Ghoddusi, Jamileh; Forghani, Maryam

    2015-01-01

    Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. Vital pulp therapy (VPT) is a way of saving deciduous teeth. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and proper vascularization of the pulp. Development of new biomaterials with suitable biocompatibility and seal has changed the attitudes towards preserving the reversible pulp in cariously exposed teeth. Before exposure and irreversible involvement of the pulp, indirect pulp capping (IPC) is the treatment of choice, but after the spread of inflammation within the pulp chamber and establishment of irreversible pulpitis, removal of inflamed pulp tissue is recommended. In this review, new concepts in preservation of the healthy pulp tissue in deciduous teeth and induction of the reparative dentin formation with new biomaterials instead of devitalization and the consequent destruction of vital tissues are discussed. PMID:25598803

  6. A review of antibiotic therapy for pelvic inflammatory disease.

    PubMed

    Duarte, Rui; Fuhrich, Daniele; Ross, Jonathan D C

    2015-09-01

    Pelvic inflammatory disease (PID) is a gynaecological inflammatory disorder with a high incidence that can lead to sequelae such as infertility, ectopic pregnancy and chronic pelvic pain. The International Union against Sexually Transmitted Infections (IUSTI) and the US Centers for Disease Control and Prevention (CDC) have issued treatment recommendations for the management of PID. The purpose of this review is to summarise the available evidence for the use of IUSTI- and CDC-recommended antibiotic therapies for PID. The main differences between recommendations concern alternative regimens for inpatient treatment and the use of oral moxifloxacin as an alternative outpatient regimen in the IUSTI guidelines. There is evidence supporting the use of the recommended antibiotic regimens, although with some variation in reported cure rates. This variation can be explained, in part, by the different diagnostic and evaluation criteria used in different trials. Adverse events that require discontinuation of antibiotic therapy are rarely observed. The main limitation of the current available evidence is the short-term follow-up, which does not allow full evaluation of the risks of long-term sequelae. PMID:26126798

  7. Beta-blocking agents during electroconvulsive therapy: a review.

    PubMed

    Boere, E; Birkenhäger, T K; Groenland, T H N; van den Broek, W W

    2014-07-01

    Electroconvulsive therapy (ECT) is associated with at least transient episodes of hypertension and tachycardia. Beta-blocking agents may be indicated to prevent cardiovascular complications and may shorten seizure duration. This review evaluates studies that used beta-blocking agents during ECT to determine which agent has the most favourable outcomes on cardiovascular variables and seizure duration. A Medline database search was made using the combined keywords 'adrenergic beta-antagonists' and 'electroconvulsive therapy'. The search was restricted to double-blind randomized controlled trials and yielded 29 original studies. With the use of esmolol, significant attenuating effects were found on cardiovascular parameters in the first 5 min after stimulation; its shortening effects on seizure duration may be dose-related. With the use of labetalol, findings on cardiovascular effects were inconsistent during the first minutes after stimulation but were significant after 5 min and thereafter; seizure duration was scarcely studied. Landiolol attenuates heart rate but with inconsistent findings regarding arterial pressure (AP); seizure duration was mostly unaffected. Esmolol appears to be effective in reducing the cardiovascular response, although seizure duration may be affected with higher dosages. Landiolol can be considered a suitable alternative, but effects on AP need further investigation. Labetalol has been studied to a lesser extent and may have prolonged cardiovascular effects. The included studies varied in design, methodology, and the amount of exact data provided in the publications. Further study of beta-blocking agents in ECT is clearly necessary. PMID:24942714

  8. Laser-driven beam lines for delivering intensity modulated radiation therapy with particle beams

    SciTech Connect

    Hofmann, K. M.; Schell, S.; Wilkens, J. J.

    2013-07-26

    Laser-accelerated particles can provide a promising opportunity for radiation therapy of cancer. Potential advantages arise from combining a compact, cost-efficient treatment unit with the physical advantages in dose delivery of charged particle beams. We consider different dose delivery schemes and the required devices to design a possible treatment unit. The secondary radiation produced in several beam line elements remains a challenge to be addressed.

  9. Radiolabeling of magnetic particles with rhenium-188 for cancer therapy

    NASA Astrophysics Data System (ADS)

    Häfeli, Urs; Pauer, Gayle; Failing, Sarah; Tapolsky, Gilles

    2001-01-01

    A one-step radiolabeling procedure of highly magnetic particles with the therapeutic ?-emitter rhenium-188 ( 188Re) has been developed. Magnetic targeted carriers (MTCs) are composites of metallic iron and activated carbon that can be labeled in the presence of the reducing agent SnCl 2. As MTCs are effectively targeted to solid tumors, the 188Re-MTC complex has the potential to deliver therapeutically relevant doses of radiation to tumors while minimizing radiation exposure to surrounding tissues or organs.

  10. The effectiveness of art therapy in the treatment of traumatized adults: a systematic review on art therapy and trauma.

    PubMed

    Schouten, Karin Alice; de Niet, Gerrit J; Knipscheer, Jeroen W; Kleber, Rolf J; Hutschemaekers, Giel J M

    2015-04-01

    Art therapy has often been applied in the treatment of traumatized adults, and good results in clinical practice have been reported. However, although art therapy experts underline these benefits, the effectiveness of art therapy in trauma treatment has not been established by systematic review. The aim of this systematic review is to identify and evaluate empirical evidence of the effectiveness of art therapy for trauma treatment. As a result of the systematic review, six controlled, comparative studies on art therapy for trauma in adult patients were found. In half of the included studies, a significant decrease in psychological trauma symptoms was found in the treatment groups, and one study reported a significant decrease in depression. Although there are limitations in the number of included studies, the number of participants, the heterogeneity of included studies, and their methodological quality, the results contribute to insight into the effectiveness of art therapy in trauma treatment and form an evidence base for the urgent need for further research on art therapy and trauma treatment. PMID:25403446

  11. A modern literature review of carbon monoxide poisoning theories, therapies, and potential targets for therapy advancement.

    PubMed

    Roderique, Joseph D; Josef, Christopher S; Feldman, Michael J; Spiess, Bruce D

    2015-08-01

    The first descriptions of carbon monoxide (CO) and its toxic nature appeared in the literature over 100 years ago in separate publications by Drs. Douglas and Haldane. Both men ascribed the deleterious effects of this newly discovered gas to its strong interaction with hemoglobin. Since then the adverse sequelae of CO poisoning has been almost universally attributed to hypoxic injury secondary to CO occupation of oxygen binding sites on hemoglobin. Despite a mounting body of literature suggesting other mechanisms of injury, this pathophysiology and its associated oxygen centric therapies persists. This review attempts to elucidate the remarkably complex nature of CO as a gasotransmitter. While CO's affinity for hemoglobin remains undisputed, new research suggests that its role in nitric oxide release, reactive oxygen species formation, and its direct action on ion channels is much more significant. In the course of understanding the multifaceted character of this simple molecule it becomes apparent that current oxygen based therapies meant to displace CO from hemoglobin may be insufficient and possibly harmful. Approaching CO as a complex gasotransmitter will help guide understanding of the complex and poorly understood sequelae and illuminate potentials for new treatment modalities. PMID:25997893

  12. A review of therapies for diabetic macular oedema and rationale for combination therapy.

    PubMed

    Amoaku, W M K; Saker, S; Stewart, E A

    2015-09-01

    Diabetic macular oedema (DMO) is responsible for significant visual impairment in diabetic patients. The primary cause of DMO is fluid leakage resulting from increased vascular permeability through contributory anatomical and biochemical changes. These include endothelial cell (EC) death or dysfunction, pericyte loss or dysfunction, thickened basement membrane, loss or dysfunction of glial cells, and loss/change of EC Glycocalyx. The molecular changes include increased reactive oxygen species, pro-inflammatory changes: advanced glycation end products, intracellular adhesion molecule-1, Complement 5-9 deposition and cytokines, which result in increased paracellular permeability, tight junction disruption, and increased transcellular permeability. Laser photocoagulation has been the mainstay of treatment until recently when pharmacological treatments were introduced. The current treatments for DMO target reducing vascular leak in the macula once it has occurred, they do not attempt to treat the underlying pathology. These pharmacological treatments are aimed at antagonising vascular endothelial growth factor (VEGF) or non-VEGF inflammatory pathways, and include intravitreal injections of anti-VEGFs (ranibizumab, aflibercept or bevacizumab) or steroids (fluocinolone, dexamethasone or triamcinolone) as single therapies. The available evidence suggests that each individual treatment modality in DMO does not result in a completely dry macula in most cases. The ideal treatment for DMO should improve vision and improve morphological changes in the macular (eg, reduce macular oedema) for a significant duration, reduced adverse events, reduced treatment burden and costs, and be well tolerated by patients. This review evaluates the individual treatments available as monotherapies, and discusses the rationale and potential for combination therapy in DMO. A comprehensive review of clinical trials related to DMO and their outcomes was completed. Where phase III randomised control trials were available, these were referenced, if not available, phase II trials have been included. PMID:26113500

  13. Antipsychotic Therapy During Early and Late Pregnancy. A Systematic Review

    PubMed Central

    Gentile, Salvatore

    2010-01-01

    Objective: Both first- (FGAs) and second-generation antipsychotics (SGAs) are routinely used in treating severe and persistent psychiatric disorders. However, until now no articles have analyzed systematically the safety of both classes of psychotropics during pregnancy. Data sources and search strategy: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, TOXNET, EMBASE, and The Cochrane Library. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from companies developing drugs. Search terms were pregnancy, psychotropic drugs, (a)typical-first-second-generation antipsychotics, and neuroleptics. A separate search was also conducted to complete the safety profile of each reviewed medication. Searches were last updated on July 2008. Data selection: All articles reporting primary data on the outcome of pregnancies exposed to antipsychotics were acquired, without methodological limitations. Conclusions: Reviewed information was too limited to draw definite conclusions on structural teratogenicity of FGAs and SGAs. Both classes of drugs seem to be associated with an increased risk of neonatal complications. However, most SGAs appear to increase risk of gestational metabolic complications and babies large for gestational age and with mean birth weight significantly heavier as compared with those exposed to FGAs. These risks have been reported rarely with FGAs. Hence, the choice of the less harmful option in pregnancy should be limited to FGAs in drug-naive patients. When pregnancy occurs during antipsychotic treatment, the choice to continue the previous therapy should be preferred. PMID:18787227

  14. Kill-painting of hypoxic tumours in charged particle therapy.

    PubMed

    Tinganelli, Walter; Durante, Marco; Hirayama, Ryoichi; Krämer, Michael; Maier, Andreas; Kraft-Weyrather, Wilma; Furusawa, Yoshiya; Friedrich, Thomas; Scifoni, Emanuele

    2015-01-01

    Solid tumours often present regions with severe oxygen deprivation (hypoxia), which are resistant to both chemotherapy and radiotherapy. Increased radiosensitivity as a function of the oxygen concentration is well described for X-rays. It has also been demonstrated that radioresistance in anoxia is reduced using high-LET radiation rather than conventional X-rays. However, the dependence of the oxygen enhancement ratio (OER) on radiation quality in the regions of intermediate oxygen concentrations, those normally found in tumours, had never been measured and biophysical models were based on extrapolations. Here we present a complete survival dataset of mammalian cells exposed to different ions in oxygen concentration ranging from normoxia (21%) to anoxia (0%). The data were used to generate a model of the dependence of the OER on oxygen concentration and particle energy. The model was implemented in the ion beam treatment planning system to prescribe uniform cell killing across volumes with heterogeneous radiosensitivity. The adaptive treatment plans have been validated in two different accelerator facilities, using a biological phantom where cells can be irradiated simultaneously at three different oxygen concentrations. We thus realized a hypoxia-adapted treatment plan, which will be used for painting by voxel of hypoxic tumours visualized by functional imaging. PMID:26596243

  15. Kill-painting of hypoxic tumours in charged particle therapy

    PubMed Central

    Tinganelli, Walter; Durante, Marco; Hirayama, Ryoichi; Krämer, Michael; Maier, Andreas; Kraft-Weyrather, Wilma; Furusawa, Yoshiya; Friedrich, Thomas; Scifoni, Emanuele

    2015-01-01

    Solid tumours often present regions with severe oxygen deprivation (hypoxia), which are resistant to both chemotherapy and radiotherapy. Increased radiosensitivity as a function of the oxygen concentration is well described for X-rays. It has also been demonstrated that radioresistance in anoxia is reduced using high-LET radiation rather than conventional X-rays. However, the dependence of the oxygen enhancement ratio (OER) on radiation quality in the regions of intermediate oxygen concentrations, those normally found in tumours, had never been measured and biophysical models were based on extrapolations. Here we present a complete survival dataset of mammalian cells exposed to different ions in oxygen concentration ranging from normoxia (21%) to anoxia (0%). The data were used to generate a model of the dependence of the OER on oxygen concentration and particle energy. The model was implemented in the ion beam treatment planning system to prescribe uniform cell killing across volumes with heterogeneous radiosensitivity. The adaptive treatment plans have been validated in two different accelerator facilities, using a biological phantom where cells can be irradiated simultaneously at three different oxygen concentrations. We thus realized a hypoxia-adapted treatment plan, which will be used for painting by voxel of hypoxic tumours visualized by functional imaging. PMID:26596243

  16. Electron beam ion sources for use in second generation synchrotrons for medical particle therapy.

    PubMed

    Zschornack, G; Ritter, E; Schmidt, M; Schwan, A

    2014-02-01

    Cyclotrons and first generation synchrotrons are the commonly applied accelerators in medical particle therapy nowadays. Next generation accelerators such as Rapid Cycling Medical Synchrotrons (RCMS), direct drive accelerators, or dielectric wall accelerators have the potential to improve the existing accelerator techniques in this field. Innovative accelerator concepts for medical particle therapy can benefit from ion sources which meet their special requirements. In the present paper we report on measurements with a superconducting Electron Beam Ion Source, the Dresden EBIS-SC, under the aspect of application in combination with RCMS as a well proven technology. The measurements indicate that this ion source can offer significant advantages for medical particle therapy. We show that a superconducting EBIS can deliver ion pulses of medically relevant ions such as protons, C(4 +) and C(6 +) ions with intensities and frequencies required for RCMS [S. Peggs and T. Satogata, "A survey of Hadron therapy accelerator technology," in Proceedings of PAC07, BNL-79826- 2008-CP, Albuquerque, New Mexico, USA, 2007; A. Garonna, U. Amaldi et al., "Cyclinac medical accelerators using pulsed C(6 +)/H2(+) ion sources," in Proceedings of EBIST 2010, Stockholm, Sweden, July 2010]. Ion extraction spectra as well as individual ion pulses have been measured. For example, we report on the generation of proton pulses with up to 3 × 10(9) protons per pulse and with frequencies of up to 1000 Hz at electron beam currents of 600 mA. PMID:24593601

  17. Isoniazid preventive therapy in correctional facilities: a systematic review.

    PubMed

    Al-Darraji, H A A; Kamarulzaman, A; Altice, F L

    2012-07-01

    Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide and the main cause of death in correctional facilities in middle- and low-income countries. Due to the closed environment and the concentration of individuals with TB-related risk factors, effective measures are required to control TB in such settings. Isoniazid preventive therapy (IPT) represents an effective and cost-effective measure. Despite international recommendations that IPT be integral to TB control, it is seldom deployed. A systematic review of interventions used to assess IPT initiation and completion in correctional facilities was conducted using published studies from two biomedical databases and relevant keywords. Additional references were reviewed, resulting in 18 eligible studies. Most (72%) studies were conducted in the United States and in jail settings (60%), with the main objective of improving completion rates inside the facility or after release. Studies that provided data about initiation and completion rates showed poor success in correctional facilities. Adverse consequences and treatment interruption ranged from 1% to 55% (median 5%) in reported studies; hepatotoxicity was the most prevalent adverse reaction. Despite its accelerating effect on the development of active TB, information on human immunodeficiency virus (HIV) status was provided in only half of the studies. Among the four studies where IPT effectiveness was assessed, the results mirror those described in community settings. Future studies require thorough assessments of IPT initiation and completion rates and adverse effects, particularly in low- and middle-income countries and where comorbid viral hepatitis may contribute significantly to outcomes, and in settings where TB and HIV are more endemic. PMID:22410101

  18. Ridge Preservation for Implant Therapy: a Review of the Literature

    PubMed Central

    Tomlin, Elizabeth M; Nelson, Shelby J; Rossmann, Jeffrey A

    2014-01-01

    Healing of the extraction socket after tooth removal involves retention of the blood clot followed by a sequence of events that lead to changes in the alveolar process in a three dimensional fashion. This normal healing event results in a minimal loss of vertical height (around 1 mm), but a substantial loss of width in the buccal-lingual plane (4-6 mm). During the first three months following extraction that loss has been shown to be significant and may result in both a hard tissue and soft tissue deformity affecting the ability to restore the site with acceptable esthetics. Procedures that reduce the resorptive process have been shown to be predictable and potentially capable of eliminating secondary surgery for site preparation when implant therapy is planned. The key element is prior planning by the dental therapist to act at the time of extraction to prevent the collapse of the ridge due to the loss of the alveolus. Several techniques have been employed as ridge preservation procedures involving the use of bone grafts, barrier membranes and biologics to provide a better restorative outcome. This review will explore the evidence behind each technique and their efficacy in accomplishing site preparation. The literature does not identify a single technique as superior to others; however, all accepted therapeutic procedures for ridge preservation have been shown to be more effective than blood clot alone in randomized controlled studies. PMID:24893595

  19. Nanotechnology in Corneal Neovascularization Therapy—A Review

    PubMed Central

    Gonzalez, Lilian; Loza, Raymond J.; Han, Kyu-Yeon; Sunoqrot, Suhair; Cunningham, Christy; Purta, Patryk; Drake, James; Jain, Sandeep; Hong, Seungpyo

    2013-01-01

    Abstract Nanotechnology is an up-and-coming branch of science that studies and designs materials with at least one dimension sized from 1–100?nm. These nanomaterials have unique functions at the cellular, atomic, and molecular levels.1 The term “nanotechnology” was first coined in 1974.2 Since then, it has evolved dramatically and now consists of distinct and independent scientific fields. Nanotechnology is a highly studied topic of interest, as nanoparticles can be applied to various fields ranging from medicine and pharmacology, to chemistry and agriculture, to environmental science and consumer goods.3 The rapidly evolving field of nanomedicine incorporates nanotechnology with medical applications, seeking to give rise to new diagnostic means, treatments, and tools. Over the past two decades, numerous studies that underscore the successful fusion of nanotechnology with novel medical applications have emerged. This has given rise to promising new therapies for a variety of diseases, especially cancer. It is becoming abundantly clear that nanotechnology has found a place in the medical field by providing new and more efficient ways to deliver treatment. Ophthalmology can also stand to benefit significantly from the advances in nanotechnology research. As it relates to the eye, research in the nanomedicine field has been particularly focused on developing various treatments to prevent and/or reduce corneal neovascularization among other ophthalmologic disorders. This review article aims to provide an overview of corneal neovascularization, currently available treatments, and where nanotechnology comes into play. PMID:23425431

  20. Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

    PubMed Central

    Song, Hyun Seok; Kim, Ji Soo

    2011-01-01

    Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are 1) to enhance gaze stability, 2) to enhance postural stability, 3) to improve vertigo, and 4) to improve activities of daily living. VRT facilitates vestibular recovery mechanisms: vestibular adaptation, substitution by the other eye-movement systems, substitution by vision, somatosensory cues, other postural strategies, and habituation. The key exercises for VRT are head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks, repeating the movements provoking vertigo, and exposing patients gradually to various sensory and motor environments. VRT is indicated for any stable but poorly compensated vestibular lesion, regardless of the patient's age, the cause, and symptom duration and intensity. Vestibular suppressants, visual and somatosensory deprivation, immobilization, old age, concurrent central lesions, and long recovery from symptoms, but there is no difference in the final outcome. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery. Here the authors review the mechanisms and the key exercises for each of the VRT goals. PMID:22259614

  1. Family Therapy for Drug Abuse: Review and Updates 2003-2010

    ERIC Educational Resources Information Center

    Rowe, Cynthia L.

    2012-01-01

    Just 15 years ago, Liddle and Dakof ("Journal of Marital and Family Therapy," 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable…

  2. Acceptance and Commitment Therapy for Psychological and Physiological Illnesses: A Systematic Review for Social Workers

    ERIC Educational Resources Information Center

    Montgomery, Katherine L.; Kim, Johnny S.; Franklin, Cynthia

    2011-01-01

    Social workers provide services to a variety of clients and are challenged with finding interventions that meet the multifaceted needs of diverse populations. Acceptance and commitment therapy (ACT) is becoming an increasingly popular therapy that offers flexibility and effectiveness in treating challenging cases. The purpose of this review is to…

  3. Therapies for onychomycosis a systematic review and network meta-analysis of mycological cure.

    PubMed

    Gupta, Aditya K; Daigle, Deanne; Paquet, Maryse

    2015-07-01

    New therapies for onychomycosis continue to be developed, yet treatments are seldom directly compared in randomized controlled trials. The objective of this study was to compare the rates of mycological cure for oral and topical onychomycosis treatments using network meta-analysis. A systematic review of the literature on onychomycosis treatments published before March 25, 2013, was performed, and data were analyzed using network meta-analysis. Terbinafine, 250 mg, therapy was significantly superior to all treatments except itraconazole, 400 mg, pulse therapy; itraconazole, 200 mg, therapy was significantly superior to fluconazole and the topical treatments; and fluconazole, efinaconazole, ciclopirox, terbinafine nail solution, and amorolfine treatments were significantly superior to only placebo. These results support the superiority of 12-week continuous terbinafine, 250 mg, therapy and itraconazole, 400 mg, pulse therapy (1 week per month for 3 months) while suggesting the equivalence of topical therapies. These results reflect findings from the literature and treatment efficacy observed in clinical practice. PMID:25032982

  4. Electroconvulsive therapy during pregnancy: a systematic review of case studies.

    PubMed

    Leiknes, Kari Ann; Cooke, Mary Jennifer; Jarosch-von Schweder, Lindy; Harboe, Ingrid; Høie, Bjørg

    2015-02-01

    This study aims to explore practice, use, and risk of electroconvulsive therapy (ECT) in pregnancy. A systematic search was undertaken in the databases Medline, Embase, PsycINFO, SveMed and CINAHL (EBSCO). Only primary data-based studies reporting ECT undertaken during pregnancy were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria and extracted detailed use, practice, and adverse effects data from full text retrieved articles. Studies and extracted data were sorted according to before and after year 1970, due to changes in ECT administration over time. A total of 67 case reports were included and studies from all continents represented. Altogether, 169 pregnant women were identified, treated during pregnancy with a mean number of 9.4 ECTs, at mean age of 29 years. Most women received ECT during the 2nd trimester and many were Para I. Main diagnostic indication in years 1970 to 2013 was Depression/Bipolar disorder (including psychotic depression). Missing data on fetus/child was 12 %. ECT parameter report was often sparse. Both bilateral and unilateral electrode placement was used and thiopental was the main anesthetic agent. Adverse events such as fetal heart rate reduction, uterine contractions, and premature labor (born between 29 and 37 gestation weeks) were reported for nearly one third (29 %). The overall child mortality rate was 7.1 %. Lethal outcomes for the fetus and/or baby had diverse associations. ECT during pregnancy is advised considered only as last resort treatment under very stringent diagnostic and clinical indications. Updated international guidelines are urgently needed. PMID:24271084

  5. Emotionally Focused Couples Therapy: A Review of the Literature.

    ERIC Educational Resources Information Center

    Messer, Larry D., Jr.

    Emotionally Focused Therapy (EFT) is an approach for working with couples that focuses on the negative interaction cycles perpetuated by deep-seated emotional vulnerabilities. This therapy attempts to alleviate distress by intervening on an emotional level in order to promote more caring interactions that can enhance relationships. Proponents…

  6. A Critical Review of Alpha Radionuclide Therapy—How to Deal with Recoiling Daughters?

    PubMed Central

    de Kruijff, Robin M.; Wolterbeek, Hubert T.; Denkova, Antonia G.

    2015-01-01

    This review presents an overview of the successes and challenges currently faced in alpha radionuclide therapy. Alpha particles have an advantage in killing tumour cells as compared to beta or gamma radiation due to their short penetration depth and high linear energy transfer (LET). Touching briefly on the clinical successes of radionuclides emitting only one alpha particle, the main focus of this article lies on those alpha-emitting radionuclides with multiple alpha-emitting daughters in their decay chain. While having the advantage of longer half-lives, the recoiled daughters of radionuclides like 224Ra (radium), 223Ra, and 225Ac (actinium) can do significant damage to healthy tissue when not retained at the tumour site. Three different approaches to deal with this problem are discussed: encapsulation in a nano-carrier, fast uptake of the alpha emitting radionuclides in tumour cells, and local administration. Each approach has been shown to have its advantages and disadvantages, but when larger activities need to be used clinically, nano-carriers appear to be the most promising solution for reducing toxic effects, provided there is no accumulation in healthy tissue. PMID:26066613

  7. A Critical Review of Alpha Radionuclide Therapy-How to Deal with Recoiling Daughters?

    PubMed

    de Kruijff, Robin M; Wolterbeek, Hubert T; Denkova, Antonia G

    2015-01-01

    This review presents an overview of the successes and challenges currently faced in alpha radionuclide therapy. Alpha particles have an advantage in killing tumour cells as compared to beta or gamma radiation due to their short penetration depth and high linear energy transfer (LET). Touching briefly on the clinical successes of radionuclides emitting only one alpha particle, the main focus of this article lies on those alpha-emitting radionuclides with multiple alpha-emitting daughters in their decay chain. While having the advantage of longer half-lives, the recoiled daughters of radionuclides like 224Ra (radium), 223Ra, and 225Ac (actinium) can do significant damage to healthy tissue when not retained at the tumour site. Three different approaches to deal with this problem are discussed: encapsulation in a nano-carrier, fast uptake of the alpha emitting radionuclides in tumour cells, and local administration. Each approach has been shown to have its advantages and disadvantages, but when larger activities need to be used clinically, nano-carriers appear to be the most promising solution for reducing toxic effects, provided there is no accumulation in healthy tissue. PMID:26066613

  8. Characterization of scintillator crystals for usage as prompt gamma monitors in particle therapy

    NASA Astrophysics Data System (ADS)

    Roemer, K.; Pausch, G.; Bemmerer, D.; Berthel, M.; Dreyer, A.; Golnik, C.; Hueso-González, F.; Kormoll, T.; Petzoldt, J.; Rohling, H.; Thirolf, P.; Wagner, A.; Wagner, L.; Weinberger, D.; Fiedler, F.

    2015-10-01

    Particle therapy in oncology is advantageous compared to classical radiotherapy due to its well-defined penetration depth. In the so-called Bragg peak, the highest dose is deposited; the tissue behind the cancerous area is not exposed. Different factors influence the range of the particle and thus the target area, e.g. organ motion, mispositioning of the patient or anatomical changes. In order to avoid over-exposure of healthy tissue and under-dosage of cancerous regions, the penetration depth of the particle has to be monitored, preferably already during the ongoing therapy session. The verification of the ion range can be performed using prompt gamma emissions, which are produced by interactions between projectile and tissue, and originate from the same location and time of the nuclear reaction. The prompt gamma emission profile and the clinically relevant penetration depth are correlated. Various imaging concepts based on the detection of prompt gamma rays are currently discussed: collimated systems with counting detectors, Compton cameras with (at least) two detector planes, or the prompt gamma timing method, utilizing the particle time-of-flight within the body. For each concept, the detection system must meet special requirements regarding energy, time, and spatial resolution. Nonetheless, the prerequisites remain the same: the gamma energy region (2 to 10 MeV), high counting rates and the stability in strong background radiation fields. The aim of this work is the comparison of different scintillation crystals regarding energy and time resolution for optimized prompt gamma detection.

  9. Nuclear and particle physics, astrophysics and cosmology (NPAC) capability review

    SciTech Connect

    Redondo, Antonio

    2010-01-01

    The present document represents a summary self-assessment of the status of the Nuclear and Particle Physics, Astrophysics and Cosmology (NPAC) capability across Los Alamos National Laboratory (LANL). For the purpose of this review, we have divided the capability into four theme areas: Nuclear Physics, Particle Physics, Astrophysics and Cosmology, and Applied Physics. For each theme area we have given a general but brief description of the activities under the area, a list of the Laboratory divisions involved in the work, connections to the goals and mission of the Laboratory, a brief description of progress over the last three years, our opinion of the overall status of the theme area, and challenges and issues.

  10. Modeling Combined Chemotherapy and Particle Therapy for Locally Advanced Pancreatic Cancer

    PubMed Central

    Durante, Marco; Tommasino, Francesco; Yamada, Shigeru

    2015-01-01

    Pancreatic ductal adenocarcinoma is the only cancer for which deaths are predicted to increase in 2014 and beyond. Combined radiochemotherapy protocols using gemcitabine and hypofractionated X-rays are ongoing in several clinical trials. Recent results indicate that charged particle therapy substantially increases local control of resectable and unresectable pancreas cancer, as predicted from previous radiobiology studies considering the high tumor hypoxia. Combination with chemotherapy improves the overall survival (OS). We compared published data on X-ray and charged particle clinical results with or without adjuvant chemotherapy calculating the biological effective dose. We show that chemoradiotherapy with protons or carbon ions results in 1?year OS significantly higher than those obtained with other treatment schedules. Further hypofractionation using charged particles may result in improved local control and survival. A comparative clinical trial using the standard X-ray scheme vs. the best current standard with carbon ions is crucial and may open new opportunities for this deadly disease. PMID:26217585

  11. [Creative therapy options for patients with dementia--a systematic review].

    PubMed

    Schmitt, B; Frölich, L

    2007-12-01

    The specifics of creative therapies aim at activating the creative potential of the patients in the sense of acceptance, orientation and coping with their illness "dementia" and at improving their quality of life. Creative therapies in the treatment of dementia offer the advantage of working with these patients, whose cognition and often also verbal communication skills are affected in a nonverbal way. This article presents a systematic review of studies and case studies, which could be found on the subject of the implementation of active creative therapies "music-, art-, drama- and dance-therapy" within the following databases (05/05): Medline, Psyndex Plus, PsychInfo and Cochrane. The search terms used were: "Creativ* and therapy and dementia and (stud*)", "Dance therapy and dementia", "Music therapy and dementia", "Drama therapy and dementia" and "Art therapy and dementia". As a result of this search we found seven quantitative evaluated controlled studies, three prae-post comparisons and three qualitative evaluated studies which have been finished since 1998. All of these studies included groups of at least three participants. Further reviews are mentioned in this article. This survey of studies on creative therapies for patients with dementia shows positive effects like the improvement of interaction skills. The data supplied thus supports the approach of using creative therapies in order to help patients accept dementia as their illness and finally to cope with it. The methodical approach to the registration of the therapies' effects and process-orientated contents of the therapy create a field of tension, leading to the request for a further development and validation of instruments, which allow the quantitative evaluation of parameters like liveliness, agility and interaction skills. PMID:17443437

  12. Complementary Therapies for Significant Dysfunction from Tinnitus: Treatment Review and Potential for Integrative Medicine

    PubMed Central

    Wolever, Ruth Q.; Price, Rebecca; Hazelton, A. Garrett; Dmitrieva, Natalia O.; Bechard, Elizabeth M.; Shaffer, Janet K.; Tucci, Debara L.

    2015-01-01

    Tinnitus is a prevalent and costly chronic condition; no universally effective treatment exists. Only 20% of patients who report tinnitus actually seek treatment, and when treated, most patients commonly receive sound-based and educational (SBE) therapy. Additional treatment options are necessary, however, for nonauditory aspects of tinnitus (e.g., anxiety, depression, and significant interference with daily life) and when SBE therapy is inefficacious or inappropriate. This paper provides a comprehensive review of (1) conventional tinnitus treatments and (2) promising complementary therapies that have demonstrated some benefit for severe dysfunction from tinnitus. While there has been no systematic study of the benefits of an Integrative Medicine approach for severe tinnitus, the current paper reviews emerging evidence suggesting that synergistic combinations of complementary therapies provided within a whole-person framework may augment SBE therapy and empower patients to exert control over their tinnitus symptoms without the use of medications, expensive devices, or extended programs. PMID:26457113

  13. Contemporary Cognitive Behavior Therapy: A Review of Theory, History, and Evidence.

    PubMed

    Thoma, Nathan; Pilecki, Brian; McKay, Dean

    2015-09-01

    Cognitive behavior therapy (CBT) has come to be a widely practiced psychotherapy throughout the world. The present article reviews theory, history, and evidence for CBT. It is meant as an effort to summarize the forms and scope of CBT to date for the uninitiated. Elements of CBT such as cognitive therapy, behavior therapy, and so-called "third wave" CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) are covered. The evidence for the efficacy of CBT for various disorders is reviewed, including depression, anxiety disorders, personality disorders, eating disorders, substance abuse, schizophrenia, chronic pain, insomnia, and child/adolescent disorders. The relative efficacy of medication and CBT, or their combination, is also briefly considered. Future directions for research and treatment development are proposed. PMID:26301761

  14. Combinations of Radiation Therapy and Immunotherapy for Melanoma: A Review of Clinical Outcomes

    SciTech Connect

    Barker, Christopher A.; Postow, Michael A.

    2014-04-01

    Radiation therapy has long played a role in the management of melanoma. Recent advances have also demonstrated the efficacy of immunotherapy in the treatment of melanoma. Preclinical data suggest a biologic interaction between radiation therapy and immunotherapy. Several clinical studies corroborate these findings. This review will summarize the outcomes of studies reporting on patients with melanoma treated with a combination of radiation therapy and immunotherapy. Vaccine therapies often use irradiated melanoma cells, and may be enhanced by radiation therapy. The cytokines interferon-? and interleukin-2 have been combined with radiation therapy in several small studies, with some evidence suggesting increased toxicity and/or efficacy. Ipilimumab, a monoclonal antibody which blocks cytotoxic T-lymphocyte antigen-4, has been combined with radiation therapy in several notable case studies and series. Finally, pilot studies of adoptive cell transfer have suggested that radiation therapy may improve the efficacy of treatment. The review will demonstrate that the combination of radiation therapy and immunotherapy has been reported in several notable case studies, series and clinical trials. These clinical results suggest interaction and the need for further study.

  15. The Current Status and Future Directions of Heavy Charged Particle Therapy in Medicine

    NASA Astrophysics Data System (ADS)

    Levy, Richard P.; Blakely, Eleanor A.; Chu, William T.; Coutrakon, George B.; Hug, Eugen B.; Kraft, Gerhard; Tsujii, Hirohiko

    2009-03-01

    As aggressive, 3D-conformal treatment has become the clearly accepted goal of radiation oncology, heavy charged-particle treatment with protons and heavier ions has concurrently and relentlessly ascended to the forefront. Protons and helium nuclei, with relatively low linear-energy-transfer (LET) properties, have consistently been demonstrated to be beneficial for aggressive (high-dose) local treatment of many types of tumors. Protons have been applied to the majority of solid tumors, and have reached a high degree of general acceptance in radiation oncology after three decades and 55,000 patients treated. However, some 15% to 20% of tumor types have proven resistant to even the most aggressive low-LET irradiation. For these radio-resistant tumors, treatment with heavier ions (e.g., carbon) offers great potential benefit. These high-LET particles have increased relative biological effectiveness (RBE) that reaches its maximum in the Bragg peak. Irradiation with these heavier ions offers the unique combination of excellent 3D-dose distribution and increased RBE. We are presently witnessing several, important parallel developments in particle therapy. Protons will likely continue their exponential growth phase, and more compact design systems will make protons available to a larger patient population—thus becoming the "heavy charged particle of choice" for Cancer Centers with limited financial resources. In parallel, major academic efforts will further advance the field of heavier ion therapy, exploring all opportunities for particle treatment and continuing the search for the ideal particle(s) for specific tumors. The future of ion therapy will be best realized by clinical trials that have ready access to top-quality delivery of both protons and heavier ions that can be accurately shaped for treatment of a specific pathology, and which will permit direct randomized-trial comparison of the effectiveness of the various ions for different diseases. Optimal results will require: (1) sophisticated target delineation that integrates CT, MRI and PET imaging; (2) reliable RBE modeling algorithms; (3) efficient beam-scanning technology that compensates for organ movements; (4) online beam control proximal to and within the patient; and (5) better understanding of dose-fractionation parameters. The current status and the anticipated future directions of the role of particle therapy in medicine is a complex subject that involves a very intimate interplay of radiobiology, accelerator physics and radiation oncology. The intention of this relatively brief manuscript is to describe the underlying principles, present the historical developments, highlight the clinical results, focus on the technical advances, and suggest likely future directions. We have also attempted to present a balanced, consensus view of the past achievements and current strategies in particle therapy, in a manner of interest both to long-term experts and to educated newcomers to this field.

  16. The Current Status and Future Directions of Heavy Charged Particle Therapy in Medicine

    SciTech Connect

    Levy, Richard P.; Blakely, Eleanor A.; Chu, William T.; Coutrakon, George B.; Hug, Eugen B.; Kraft, Gerhard; Tsujii, Hirohiko

    2009-03-10

    As aggressive, 3D-conformal treatment has become the clearly accepted goal of radiation oncology, heavy charged-particle treatment with protons and heavier ions has concurrently and relentlessly ascended to the forefront. Protons and helium nuclei, with relatively low linear-energy-transfer (LET) properties, have consistently been demonstrated to be beneficial for aggressive (high-dose) local treatment of many types of tumors. Protons have been applied to the majority of solid tumors, and have reached a high degree of general acceptance in radiation oncology after three decades and 55,000 patients treated. However, some 15% to 20% of tumor types have proven resistant to even the most aggressive low-LET irradiation. For these radio-resistant tumors, treatment with heavier ions (e.g., carbon) offers great potential benefit. These high-LET particles have increased relative biological effectiveness (RBE) that reaches its maximum in the Bragg peak. Irradiation with these heavier ions offers the unique combination of excellent 3D-dose distribution and increased RBE. We are presently witnessing several, important parallel developments in particle therapy. Protons will likely continue their exponential growth phase, and more compact design systems will make protons available to a larger patient population - thus becoming the 'heavy charged particle of choice' for Cancer Centers with limited financial resources. In parallel, major academic efforts will further advance the field of heavier ion therapy, exploring all opportunities for particle treatment and continuing the search for the ideal particle(s) for specific tumors. The future of ion therapy will be best realized by clinical trials that have ready access to top-quality delivery of both protons and heavier ions that can be accurately shaped for treatment of a specific pathology, and which will permit direct randomized-trial comparison of the effectiveness of the various ions for different diseases. Optimal results will require: (1) sophisticated target delineation that integrates CT, MRI and PET imaging; (2) reliable RBE modeling algorithms; (3) efficient beam-scanning technology that compensates for organ movements; (4) online beam control proximal to and within the patient; and (5) better understanding of dose-fractionation parameters. The current status and the anticipated future directions of the role of particle therapy in medicine is a complex subject that involves a very intimate interplay of radiobiology, accelerator physics and radiation oncology. The intention of this relatively brief manuscript is to describe the underlying principles, present the historical developments, highlight the clinical results, focus on the technical advances, and suggest likely future directions. We have also attempted to present a balanced, consensus view of the past achievements and current strategies in particle therapy, in a manner of interest both to long-term experts and to educated newcomers to this field.

  17. An improved Monte Carlo (MC) dose simulation for charged particle cancer therapy

    SciTech Connect

    Ying, C. K.; Kamil, W. A.; Shuaib, I. L.; Matsufuji, Naruhiro

    2014-02-12

    Heavy-particle therapy such as carbon ion therapy are more popular nowadays because of the nature characteristics of charged particle and almost no side effect to patients. An effective treatment is achieved with high precision of dose calculation, in this research work, Geant4 based Monte Carlo simulation method has been used to calculate the radiation transport and dose distribution. The simulation have the same setting with the treatment room in Heavy Ion Medical Accelerator, HIMAC. The carbon ion beam at the isocentric gantry nozzle for the therapeutic energy of 290 MeV/u was simulated, experimental work was carried out in National Institute of Radiological Sciences, NIRS, Chiba, Japan by using the HIMAC to confirm the accuracy and qualities dose distribution by MC methods. The Geant4 based simulated dose distribution were verified with measurements for Bragg peak and spread out Bragg peak (SOBP) respectively. The verification of results shows that the Bragg peak depth-dose and SOBP distributions in simulation has good agreement with measurements. In overall, the study showed that Geant4 based can be fully applied in the heavy-ion therapy field for simulation, further works need to be carry on to refine and improve the Geant4 MC simulations.

  18. Review of ion beam therapy: Present and Future

    SciTech Connect

    Alonso, Jose R.

    2000-06-01

    First therapy efforts at the Bevalac using neon ions took place in the 70's and 80's. Promising results led to construction of HIMAC in Chiba Japan, and more recently to therapy trials at GSI. Both these facilities are now treating patients with carbon beams. Advances in both accelerator technology and beam delivery have taken place at these two centers. Plans are well along for new facilities in Europe and Japan.

  19. Elderly health and literature therapy: a theoretical review.

    PubMed

    Eum, Yeongcheol; Yim, Jongeun; Choi, Wonjae

    2014-01-01

    Recently, the problems of old age have been discussed in terms of two aspects: preventive and therapeutic approach. The previous studies on the preventive aspect have been mostly concerned with the educational preparation for successful approach to elderly, directing focus toward the transitional period of the old age. Most research into the therapeutic aspect on the elderly diseases has focused on organic mental disorders such as dementia and functional mental diseases such as depression. This study aims to suggest the preventive and new therapeutic possibility in old people through combining the elderly health with literature. First, the research results regarding the social background for the elderly problems indicate that geriatric diseases increase in proportion to the increase of the population. Secondly, for the literature therapy, it is initially required to seek a comprehensive understanding about the health of the elderly through the phased consideration for the elderly problems. Thirdly, for the treatment of geriatric diseases by using literature, it is necessary to develop more active and integrative literature therapy than passive bibliotherapy. Literature therapy is the use of literature in the treatment of people with emotional or mental illness. Fourthly, theoretical approach should be considered for the health of the elderly and the literature therapy. From a literary approach, the literature therapy can help the study on geriatric diseases such as dementia and depression. Thus, the program for the health of geriatric issues and literature therapy should be developed as the next step in the future. PMID:24522118

  20. Problem-Solving Therapy for Depression in Adults: A Systematic Review

    ERIC Educational Resources Information Center

    Gellis, Zvi D.; Kenaley, Bonnie

    2008-01-01

    Objectives: This article presents a systematic review of the evidence on problem-solving therapy (PST) for depressive disorders in noninstitutionalized adults. Method: Intervention studies using randomized controlled designs are included and methodological quality is assessed using a standard set of criteria from the Cochrane Collaborative Review

  1. Water-soluble core/shell nanoparticles for proton therapy through particle-induced radiation

    NASA Astrophysics Data System (ADS)

    Park, Jeong Chan; Jung, Myung-Hwan; Kim, Maeng Jun; Kim, Kye-Ryung

    2015-02-01

    Metallic nanoparticles have been used in biomedical applications such as magnetic resonance imaging (MRI), therapy, and drug delivery systems. Metallic nanoparticles as therapeutic tools have been demonstrated using radio-frequency magnetic fields or near-infrared light. Recently, therapeutic applications of metallic nanomaterials combined with proton beams have been reported. Particle-induced radiation from metallic nanoparticles, which can enhance the therapeutic effects of proton therapy, was released when the nanoparticles were bombarded by a high-energy proton beam. Core/shell nanoparticles, especially Au-coated magnetic nanoparticles, have drawn attention in biological applications due to their attractive characteristics. However, studies on the phase transfer of organic-ligand-based core/shell nanoparticles into water are limited. Herein, we demonstrated that hydrophobic core/shell structured nanomaterials could be successfully dispersed in water through chloroform/surfactant mixtures. The effects of the core/shell nanomaterials and the proton irradiation on Escherichia coli (E. coli) were also explored.

  2. Chinese Physics C Vol. 38, No. 9 (2014) 090001 1 REVIEW OF PARTICLE PHYSICS*

    E-print Network

    California at Santa Cruz, University of

    2014-01-01

    Chinese Physics C Vol. 38, No. 9 (2014) 090001 1 REVIEW OF PARTICLE PHYSICS* ParticleDataGroup Abstract The Review summarizes much of particle physics and cosmology. Using data from previous editions or heavily revised including those on: Dark Energy, Higgs Boson Physics, Electroweak Model, Neutrino Cross

  3. Hormone therapy in hypospadias surgery: a systematic review.

    PubMed

    Netto, Jose Murillo B; Ferrarez, Carlos Eduardo P F; Schindler Leal, Anucha Andrade; Tucci, Silvio; Gomes, Carlos Augusto; Barroso, Ubirajara

    2013-12-01

    Surgical correction of hypospadias is proposed to improve the aesthetic and functional quality of the penis. Hormone therapy preceding surgical correction is indicated to obtain better surgical conditions. However, there is divergence in the literature regarding the hormone therapy of choice, time of its use before surgery, appropriate dose, and route of application. To try to elucidate this matter, an electronic survey of the databases PubMed and Cochrane Central Library was conducted, limited to articles in English published since 1980. Search strategy identified 14 clinical trials that matched the inclusion criteria. Analysis was made in terms of study design, classification of hypospadias, association with chordee and cryptorchidism, type of hormone, route of application, dose and duration of treatment, penile length before and after hormone therapy, glans circumference before and after hormone therapy, adverse effects, and surgical complications. From the trials evaluated it was not possible to determine the ideal neoadjuvant treatment. A preference for use of testosterone was observed. Intramuscular administration seems to have fewer adverse effects than topical treatment. Side effects were seldom described, and treated patients were not followed on a long-term basis. The scarcity of randomized and controlled clinical trials regarding the topic impairs the establishment of a protocol. In conclusion, although preoperative hormone therapy is currently used before hypospadias surgery, its real benefit in terms of improvement of the penis and surgical results has not been defined. PMID:23602841

  4. Mesenchymal Stromal Cell Therapy in MDR/XDR Tuberculosis: A Concise Review.

    PubMed

    Joshi, Lavanya; Chelluri, Lakshmi Kiran; Gaddam, Sumanlatha

    2015-12-01

    Multi-drug-resistant (MDR) tuberculosis is a major public health problem worldwide. Drug resistance arises due to non-compliance of antibiotic therapy. Herein, we explored the therapeutic options available ranging from conservative treatment approaches to alternate adjunct therapies such as mesenchymal stromal cell (MSC) therapy interventions. It is attractive to understand the scientific rationale of using cells as drugs, in particular mesenchymal stem/stromal cells. The review dwells and attempts to analyze the mechanistic approaches of the current treatment modalities to modern therapies. MSCs have demonstrated profound capacity to regenerate and repair. They appear to modulate that the activities of dendritic cells regulate T cells, both in vivo and in vitro. While there seems to be some benefit of such therapies, its use warrants further research. The merits and de-merits of autologous therapy/allogeneic therapy are ill understood. The challenges of requirement of large number of cells for infusion, the route of administration, choice of timing are complex issues that need to be addressed. Furthermore, the host immune responses, environmental factors and epigenetic mechanisms compound the problem. Although, clinical studies are being performed using autologous MSCs in different inflammatory models, it is important that such an intervention should be based on sound scientific rationale. The current review examines the immunomodulatory properties of MSCs, its interactions with other cell types, in assessing the basis for autologous/allogeneic cell-based therapies in the treatment of XDR/MDR tuberculosis. PMID:26100384

  5. Hybrid therapy for Helicobacter pylori infection: A systemic review and meta-analysis

    PubMed Central

    Hsu, Ping-I; Lin, Pei-Chin; Graham, David Y

    2015-01-01

    AIM: To compare the effectiveness of hybrid therapy with other recommended regimens using meta-analysis. METHODS: Bibliographical searches for randomized trials comparing hybrid and other therapies were performed in PubMed, the Cochrane Library and relevant congresses up to February 2015 using the following keywords (all fields and/or MeSH): (“Helicobacter pylori” or “H. pylori”) and (“hybrid therapy” or “sequential-concomitant therapy”). Meta-analyses were performed with Cochrane Review Manager 5.1. The random effect model proposed by DerSimonian and Laird and the Mantel-Haenszel method were used to estimate the pooled relative risk and 95%CI of the efficacy outcomes between hybrid therapy and other eradication therapies. RESULTS: Eight studies (2516 subjects) met entry criteria. The antimicrobial resistance in the study groups ranged from 6.9% to 23.5%. The mean cure rates of hybrid therapy by intention-to-treat (ITT) and per-protocol analyses were 88.5% (n = 1207; range: 80.0% to 97.4%) and 93.3% (n = 1109; range: 85.7% to 99.1%), respectively. Meta-analysis showed there was no significant difference in ITT eradication rate between hybrid and sequential therapy (relative risk: 1.01; 95%CI: 0.92-1.11). Subgroup analysis revealed hybrid therapy was more effective than sequential therapy in the non-Italian populations (95%CI: 1.01-1.18) and was only less effective in one, Italian population (95%CI: 0.83-0.98). There was no significant difference in eradication rate between hybrid therapy and concomitant therapy (95%CI: 0.93-1.02). No head-to-head comparisons of hybrid therapy and standard triple therapy or bismuth quadruple therapy were found. However, a multicenter, randomized trial showed that reverse hybrid therapy was superior to standard triple therapy (95.5% vs 88.6% ITT; P = 0.011). CONCLUSION: Hybrid therapy appears to be an effective, safe, and well-tolerated treatment for H. pylori infection in the era of increasing antibiotic resistance. PMID:26668516

  6. Contextual Behavior Therapies in the Treatment of PTSD: A Review

    ERIC Educational Resources Information Center

    Mulick, Patrick S.; Landers, Sara J.; Kanter, Jonathan W.

    2005-01-01

    Empirical evidence supports cognitive-behavioral interventions for the treatment Posttraumatic Stress Disorder (PTSD), with exposure therapy typically being the most frequently utilized. While the success of exposure treatments is well established there are factors which may hinder their use in "real-world" settings (e.g., poor treatment…

  7. Integrative Care Therapies and Pain in Hospitalized Children and Adolescents: A Retrospective Database Review

    PubMed Central

    Luberto, Christina M.; Bogenschutz, Lois H.; Pelley, Terri J.; Dusek, Jeffrey

    2014-01-01

    Abstract Background: Complementary or integrative care therapies are promising adjunctive approaches to pain management for pediatric inpatients that are currently underused and understudied. The purpose of this study was to examine the potential benefits of integrative care therapies delivered to hospitalized children and adolescents at a large Midwestern academic pediatric medical center over a 1-year period. Methods: A retrospective chart review of an inpatient clinical database maintained by integrative care therapists over a 1-year period was used for the current study. Pre/post pain and relaxation scores associated with the delivery of inpatient integrative care therapies (primarily massage therapy and healing touch) were examined. Results: Five-hundred nineteen hospitalized children and adolescents were treated by integrative care therapists for primarily pain or anxiety needs. Patients had a mean age of 10.2 years (standard deviation, 7.0), 224 were female (43%), 383 were white (74%), and most (393 [77%]) received massage therapy. Mean pain and relaxation scores decreased significantly from pre- to post-therapy across all demographic and clinical subgroups (p?.001). Conclusions: Although integrative care therapies are increasingly requested and offered in children's hospitals, provision of these approaches is driven primarily by consumer demand rather than evidence-informed practice. Future controlled studies should examine the incremental effects of integrative care therapies as an adjunct to conventional treatment, assess how these therapies work mechanistically, and determine whether they improve outcomes, such as pain and cost, for hospitalized children and adolescents. PMID:24175871

  8. Physical Therapy Interventions for Degenerative Lumbar Spinal Stenosis: A Systematic Review

    PubMed Central

    Macedo, Luciana Gazzi; Hum, Abraham; Kuleba, Laura; Mo, Joey; Truong, Linda; Yeung, Mankeen

    2013-01-01

    Background Physical therapy is commonly prescribed for patients with lumbar spinal stenosis (LSS); however, little is known about its effectiveness. Purpose The purpose of this study was to systematically review randomized controlled trials (RCTs), controlled trials, and cohort studies evaluating the effectiveness of physical therapy for LSS. Data Sources Studies were searched on electronic databases to January 2012. Study Selection Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of physical therapy treatment, presence of a comparison group, and outcomes of pain, disability, function, or quality of life. Data Extraction Outcomes were extracted and, when possible, pooled using RevMan 5, a freely available review program from the Cochrane Library. Data Synthesis Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a physical therapy modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus physical therapy demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body-weight–supported treadmill walking have similar effects, and that corsets are better than no corsets. Limitations The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. Conclusions No conclusions could be drawn from the review regarding which physical therapy treatment is superior for LSS. There was low-quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long-term (2 years) outcomes for pain and disability, but not walking distance, than physical therapy in patients with LSS. PMID:23886845

  9. Research Ethics: Institutional Review Board Oversight of Art Therapy Research

    ERIC Educational Resources Information Center

    Deaver, Sarah P.

    2011-01-01

    By having their research proposals reviewed and approved by Institutional Review Boards (IRBs), art therapists meet important ethical principles regarding responsibility to research participants. This article provides an overview of the history of human subjects protections in the United States; underlying ethical principles and their application…

  10. Review: engineering particles using the aerosol-through-plasma method

    SciTech Connect

    Phillips, Jonathan; Luhrs, Claudia C; Richard, Monique

    2009-01-01

    For decades, plasma processing of materials on the nanoscale has been an underlying enabling technology for many 'planar' technologies, particularly virtually every aspect of modern electronics from integrated-circuit fabrication with nanoscale elements to the newest generation of photovoltaics. However, it is only recent developments that suggest that plasma processing can be used to make 'particulate' structures of value in fields, including catalysis, drug delivery, imaging, higher energy density batteries, and other forms of energy storage. In this paper, the development of the science and technology of one class of plasma production of particulates, namely, aerosol-through-plasma (A-T-P), is reviewed. Various plasma systems, particularly RF and microwave, have been used to create nanoparticles of metals and ceramics, as well as supported metal catalysts. Gradually, the complexity of the nanoparticles, and concomitantly their potential value, has increased. First, unique two-layer particles were generated. These were postprocessed to create unique three-layer nanoscale particles. Also, the technique has been successfully employed to make other high-value materials, including carbon nanotubes, unsupported graphene, and spherical boron nitride. Some interesting plasma science has also emerged from efforts to characterize and map aerosol-containing plasmas. For example, it is clear that even a very low concentration of particles dramatically changes plasma characteristics. Some have also argued that the local-thermodynamic-equilibrium approach is inappropriate to these systems. Instead, it has been suggested that charged- and neutral-species models must be independently developed and allowed to 'interact' only in generation terms.

  11. An analytical review of the Chinese literature on Qigong therapy for diabetes mellitus.

    PubMed

    Chen, Kevin W; Liu, Tianjun; Zhang, Haibo; Lin, Zhongpeng

    2009-01-01

    Diabetes rates have doubled in China over the past decade. However, as conventional medicine offers neither a sound explanation nor an effective cure, patients with diabetes increasingly seek complementary and alternative therapies. It was reported that the traditional Chinese medical approach, Qigong, might produce therapeutic benefits with minimal side-effects in this condition. The Qigong Database, the China National Knowledge Infrastructure, and the library databases of Chinese institutions from 1978 to middle of 2008 on open trials, laboratory studies, and controlled clinical studies were reviewed. Over 35 studies were identified and reviewed. Qigong therapy for diabetic patients included self-practice, group qi-field therapy, external qi therapy, and Qigong in combination with other therapies. Only 2 randomized controlled trials were found; both evaluate Qigong as an adjuvant to conventional therapy. All studies reported some therapeutic effect or improvement. Some reported significant reduction in fasting plasma glucose. Others reported complete cures, which were unlikely to be the result of placebo effect as objective outcome measures were used. Qigong therapy may be an important complement to conventional medicine in treating diabetes, but the quality of studies needs to be improved. These preliminary data are promising and support the need for further randomized controlled trials. PMID:19606506

  12. Mushroom poisoning. Case reports and a review of therapy.

    PubMed

    Hanrahan, J P; Gordon, M A

    1984-02-24

    Four incidents of mushroom poisoning, representing four of the seven established groups of toxic mushrooms, are presented. These case reports illustrate the range of gastrointestinal and neurological symptoms caused by mushroom poisoning and reflect a nationwide increase in reports of serious poisonings in recent years. Severity of poisonings often parallels the time span between consumption and onset of symptoms, with serious poisonings having longer incubation periods. New therapies for amatoxin poisoning may reduce mortality caused by these poisonings. PMID:6420582

  13. Advances in 4D Treatment Planning for Scanned Particle Beam Therapy — Report of Dedicated Workshops

    PubMed Central

    Bert, Christoph; Graeff, Christian; Riboldi, Marco; Nill, Simeon; Baroni, Guido; Knopf, Antje-Christin

    2014-01-01

    We report on recent progress in the field of mobile tumor treatment with scanned particle beams, as discussed in the latest editions of the 4D treatment planning workshop. The workshop series started in 2009, with about 20 people from 4 research institutes involved, all actively working on particle therapy delivery and development. The first workshop resulted in a summary of recommendations for the treatment of mobile targets, along with a list of requirements to apply these guidelines clinically. The increased interest in the treatment of mobile tumors led to a continuously growing number of attendees: the 2012 edition counted more than 60 participants from 20 institutions and commercial vendors. The focus of research discussions among workshop participants progressively moved from 4D treatment planning to complete 4D treatments, aiming at effective and safe treatment delivery. Current research perspectives on 4D treatments include all critical aspects of time resolved delivery, such as in-room imaging, motion detection, beam application, and quality assurance techniques. This was motivated by the start of first clinical treatments of hepato cellular tumors with a scanned particle beam, relying on gating or abdominal compression for motion mitigation. Up to date research activities emphasize significant efforts in investigating advanced motion mitigation techniques, with a specific interest in the development of dedicated tools for experimental validation. Potential improvements will be made possible in the near future through 4D optimized treatment plans that require upgrades of the currently established therapy control systems for time resolved delivery. But since also these novel optimization techniques rely on the validity of the 4DCT, research focusing on alternative 4D imaging technique, such as MRI based 4DCT generation will continue. PMID:24354749

  14. A Monte Carlo tool for raster-scanning particle therapy dose computation

    NASA Astrophysics Data System (ADS)

    Jelen, U.; Radon, M.; Santiago, A.; Wittig, A.; Ammazzalorso, F.

    2014-03-01

    Purpose of this work was to implement Monte Carlo (MC) dose computation in realistic patient geometries with raster-scanning, the most advanced ion beam delivery technique, combining magnetic beam deflection with energy variation. FLUKA, a Monte Carlo package well-established in particle therapy applications, was extended to simulate raster-scanning delivery with clinical data, unavailable as built-in feature. A new complex beam source, compatible with FLUKA public programming interface, was implemented in Fortran to model the specific properties of raster-scanning, i.e. delivery by means of multiple spot sources with variable spatial distributions, energies and numbers of particles. The source was plugged into the MC engine through the user hook system provided by FLUKA. Additionally, routines were provided to populate the beam source with treatment plan data, stored as DICOM RTPlan or TRiP98's RST format, enabling MC recomputation of clinical plans. Finally, facilities were integrated to read computerised tomography (CT) data into FLUKA. The tool was used to recompute two representative carbon ion treatment plans, a skull base and a prostate case, prepared with analytical dose calculation (TRiP98). Selected, clinically relevant issues influencing the dose distributions were investigated: (1) presence of positioning errors, (2) influence of fiducial markers and (3) variations in pencil beam width. Notable differences in modelling of these challenging situations were observed between the analytical and Monte Carlo results. In conclusion, a tool was developed, to support particle therapy research and treatment, when high precision MC calculations are required, e.g. in presence of severe density heterogeneities or in quality assurance procedures.

  15. Robot therapy: a new approach for mental healthcare of the elderly - a mini-review.

    PubMed

    Shibata, Takanori; Wada, Kazuyoshi

    2011-01-01

    Mental healthcare of elderly people is a common problem in advanced countries. Recently, high technology has developed robots for use not only in factories but also for our living environment. In particular, human-interactive robots for psychological enrichment, which provide services by interacting with humans while stimulating their minds, are rapidly spreading. Such robots not only simply entertain but also render assistance, guide, provide therapy, educate, enable communication, and so on. Robot therapy, which uses robots as a substitution for animals in animal-assisted therapy and activity, is a new application of robots and is attracting the attention of many researchers and psychologists. The seal robot named Paro was developed especially for robot therapy and was used at hospitals and facilities for elderly people in several countries. Recent research has revealed that robot therapy has the same effects on people as animal therapy. In addition, it is being recognized as a new method of mental healthcare for elderly people. In this mini review, we introduce the merits and demerits of animal therapy. Then we explain the human-interactive robot for psychological enrichment, the required functions for therapeutic robots, and the seal robot. Finally, we provide examples of robot therapy for elderly people, including dementia patients. PMID:20639620

  16. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review

    PubMed Central

    2011-01-01

    Background Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness. Methods A comprehensive search was conducted in the databases Scopus, Mantis, CINHAL and the Cochrane Library for terms related to manual therapy, vestibular rehabilitation and cervicogenic dizziness. Included studies were assessed using the Maastricht-Amsterdam criteria. Results A total of fifteen articles reporting findings from thirteen unique investigations, including five randomised controlled trials and eight prospective, non-controlled cohort studies were included in this review. The methodological quality of the included studies was generally poor to moderate. All but one study reported improvement in dizziness following either unimodal or multimodal manual therapy interventions. Some studies reported improvements in postural stability, joint positioning, range of motion, muscle tenderness, neck pain and vertebrobasilar artery blood flow velocity. Discussion Although it has been argued that manual therapy combined with vestibular rehabilitation may be superior in the treatment of cervicogenic dizziness, there are currently no observational and experimental studies demonstrating such effects. A rationale for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is presented. Conclusion There is moderate evidence to support the use of manual therapy, in particular spinal mobilisation and manipulation, for cervicogenic dizziness. The evidence for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is lacking. Further research to elucidate potential synergistic effects of manual therapy and vestibular rehabilitation is strongly recommended. PMID:21923933

  17. Methodology for the systematic reviews on occupational therapy interventions for older adults with low vision.

    PubMed

    Arbesman, Marian; Lieberman, Deborah; Berlanstein, Debra R

    2013-01-01

    Systematic reviews of the literature relevant to older adults with low vision are important to the practice of occupational therapy. This article describes the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for older adults with low vision. We describe the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. In addition, we present the final number of articles included in each systematic review; a summary of the results, strengths, and limitations of the findings; and implications for practice, education, and research. PMID:23597684

  18. [Diagnosis and therapy of fungal keratitis--a review].

    PubMed

    Behrens-Baumann, W

    1997-05-01

    The diagnosis and current therapy of keratomycosis is presented in an overview. The following characteristics are helpful in clinical diagnosis: unsharp borders of the infiltrate, elevated infiltrate with initially epithelium, satellites and pyramidal hypopyon. The microbiological and microscopic confirmation is often possible only after repeated debridements. Lactophenol Blue is very suitable for staining the material obtained. Fluconazol is recommended for the local treatment of candida keratomycosis. Alternatively, amphotericin B is a potent antimycotic. However, a debridement is necessary to enhance bioavailability of this drug. If pharmacotherapy is not efficient enough, keratoplasty should be performed as soon as possible. PMID:9324527

  19. Systematic reviews of complementary therapies – an annotated bibliography. Part 2: Herbal medicine

    PubMed Central

    Linde, Klaus; ter Riet, Gerben; Hondras, Maria; Vickers, Andrew; Saller, Reinhard; Melchart, Dieter

    2001-01-01

    Background Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with herbal medicine. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of herbal medicines; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pre-tested form and summarized descriptively. Results From a total of 79 potentially relevant reviews pre-selected in the screening process 58 met the inclusion criteria. Thirty of the reports reviewed ginkgo (for dementia, intermittent claudication, tinnitus, and macular degeneration), hypericum (for depression) or garlic preparations (for cardiovascular risk factors and lower limb atherosclerosis). The quality of primary studies was criticized in the majority of the reviews. Most reviews judged the available evidence as promising but definitive conclusions were rarely possible. Conclusions Systematic reviews are available on a broad range of herbal preparations prescribed for defined conditions. There is very little evidence on the effectiveness of herbalism as practised by specialist herbalists who combine herbs and use unconventional diagnosis. PMID:11518548

  20. Systematic reviews of complementary therapies - an annotated bibliography. Part 1: Acupuncture

    PubMed Central

    Linde, Klaus; Vickers, Andrew; Hondras, Maria; ter Riet, Gerben; Thormählen, Johannes; Berman, Brian; Melchart, Dieter

    2001-01-01

    Background Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with acupuncture. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of acupuncture; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. Results From a total of 48 potentially relevant reviews preselected in a screeening process 39 met the inclusion criteria. 22 were on various pain syndromes or rheumatic diseases. Other topics addressed by more than one review were addiction, nausea, asthma and tinnitus. Almost unanimously the reviews state that acupuncture trials include too few patients. Often included trials are heterogeneous regarding patients, interventions and outcome measures, are considered to have insufficient quality and contradictory results. Convincing evidence is available only for postoperative nausea, for which acupuncture appears to be of benefit, and smoking cessation, where acupuncture is no more effective than sham acupuncture. Conclusions A large number of systematic reviews on acupuncture exists. What is most obvious from these reviews is the need for (the funding of) well-designed, larger clinical trials. PMID:11513758

  1. Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

    PubMed Central

    DeFranco, Emily A.; Valent, Amy Miyoshi; Newman, Tondra; Regan, Jodi; Smith, Jessica; Muglia, Louis J.

    2013-01-01

    The aim of this paper is to provide a thorough summary of published studies that have assessed the efficacy of adjunctive therapies used in addition to cervical cerclage as a preventive measure for preterm birth. We limited our paper to patients treated with cerclage plus an additional prophylactic therapy compared to a reference group of women with cerclage alone. The specific adjunctive therapies included in this systematic review are progesterone, reinforcing or second cerclage placement, tocolytics, antibiotics, bedrest, and pessary. We searched PubMed and Cochrane databases without date criteria with restriction to English language and human studies and performed additional bibliographic review of selected articles and identified 305 total studies for review. Of those, only 12 studies compared the use of an adjunctive therapy with cerclage to a reference group of cerclage alone. None of the 12 were prospective randomized clinical trials. No comparative studies were identified addressing the issues of antibiotics, bedrest, or pessary as adjunctive treatments to cerclage. None of the 12 studies included in this paper demonstrated a clear benefit of any adjunctive therapy used in addition to cerclage over and above cerclage used alone; however, few studies with small numbers limited the strength of the conclusions. PMID:23606847

  2. Adverse Events of Auricular Therapy: A Systematic Review

    PubMed Central

    Molassiotis, Alexander; Wang, Tao; Suen, Lorna K. P.

    2014-01-01

    The aim of this study was to systematically evaluate the literature on adverse events associated with auricular therapy (AT). Case reports, case series, surveys, and all types of clinical trials reporting adverse events of AT were included. Relevant articles were mainly retrieved from 13 electronic databases and seven Chinese journals on complementary medicine. AT-related adverse events were reported in 32 randomized controlled trials, five uncontrolled clinical trials, four case reports, and two controlled clinical trials. For auricular acupuncture, the most frequently reported adverse events were tenderness or pain at insertion, dizziness, local discomfort, minor bleeding and nausea, and so forth. For auricular acupressure, local skin irritation and discomfort, mild tenderness or pain, and dizziness were commonly reported. Skin irritation, local discomfort, and pain were detected in auricular electroacupuncture, and minor infection was identified in auricular bloodletting therapy. Most of these events were transient, mild, and tolerable, and no serious adverse events were identified. Our findings provide preliminary evidence that AT is a relatively safe approach. Considering the patient's safety, prospective or retrospective surveys are needed in future research to gather practitioner-reported and patient-reported adverse events on AT, and the quality of adverse events reporting in future AT trials should be improved. PMID:25435890

  3. Improvement of extraction efficiency from a compact synchrotron for proton beam therapy by applying particle tracking analysis

    SciTech Connect

    Ebina, Futaro; Umezawa, Masumi; Hiramoto, Kazuo

    2013-04-19

    Various types of synchrotrons are used for particle beam therapy. In particle beam therapy, especially in proton beam therapy, downsizing of the accelerator system is a major concern. A compact synchrotron dedicated for proton beam therapy is presented. The synchrotron is horizontally weakly focusing and consists of 4 H-type zerogradient dipole magnets and 4 quadrupole magnets. The circumference of the ring is a little shorter than 18 m, and the energies are up to 230MeV. Beam extraction from the synchrotron is performed by RF-driven slow extraction technology. Two sextupole magnets set in adjacent straight sections form a horizontal separatrix which is fixed during the beam extraction. Horizontal RF voltage excites betatron oscillation of the circulating beam, and protons exceeding the separatrix are extracted by an electrostatic deflector and a horizontal septum dipole magnet. To achieve adequately high extraction efficiency, the relationship between the extraction efficiency and the horizontal chromaticity of the ring is analyzed by particle tracking simulation. The horizontal chromaticity with maximum extraction efficiency is half of the theoretical value because of the distortion of the horizontal separatrix for the extraction. With this chromaticity, the spiral-step of the extracted particle is independent of the momentum deviation of the particle, and the separatrix across the electrostatic septum electrodes is superpositioned.

  4. Pharmacological therapy used in the elimination of Helicobacter pylori infection: A review

    PubMed Central

    dos Santos, Ariolana A; Carvalho, Adriana A

    2015-01-01

    The optimal therapy for Helicobacter pylori (H. pylori) infection should combine a high cure rate and a short treatment duration with a favorable side-effect profile and should maintain a low cost. Several strategies have been proposed to increase the H. pylori eradication rate, including the extension of the treatment duration to 14 d, the use of a four-drug regimen (quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as levofloxacin. However, triple therapy remains the most widely accepted first-line treatment regimen in Brazil and the United States and throughout Europe. Because this therapy is limited by resistance to clarithromycin, other therapeutic regimens have been investigated worldwide. This review describes the current literature involving studies directly comparing these different therapies and their efficacies. PMID:25574087

  5. A review of current and future medical therapies for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

    PubMed

    Mocco, J; Zacharia, Brad E; Komotar, Ricardo J; Connolly, E Sander

    2006-01-01

    In an effort to help clarify the current state of medical therapy for cerebral vasospasm, the authors reviewed the relevant literature on the established medical therapies used for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH), and they discuss burgeoning areas of investigation. Despite advances in the treatment of aneurysmal SAH, cerebral vasospasm remains a common complication and has been correlated with a 1.5- to threefold increase in death during the first 2 weeks after hemorrhage. A number of medical, pharmacological, and surgical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Although much has been elucidated regarding its pathophysiology, the treatment of cerebral vasospasm remains a dilemma. Although a poor understanding of SAH-induced cerebral vasospasm pathophysiology has, to date, hampered the development of therapeutic interventions, current research efforts promise the eventual production of new medical therapies. PMID:17029348

  6. Far-infrared therapy for cardiovascular, autoimmune, and other chronic health problems: A systematic review.

    PubMed

    Shui, Shanshan; Wang, Xia; Chiang, John Y; Zheng, Lei

    2015-10-01

    Physical therapy (physiotherapy), a complementary and alternative medicine therapy, has been widely applied in diagnosing and treating various diseases and defects. Increasing evidence suggests that convenient and non-invasive far-infrared (FIR) rays, a vital type of physiotherapy, improve the health of patients with cardiovascular disease, diabetes mellitus, and chronic kidney disease. Nevertheless, the molecular mechanisms by which FIR functions remain elusive. Hence, the purpose of this study was to review and summarize the results of previous investigations and to elaborate on the molecular mechanisms of FIR therapy in various types of disease. In conclusion, FIR therapy may be closely related to the increased expression of endothelial nitric oxide synthase as well as nitric oxide production and may modulate the profiles of some circulating miRNAs; thus, it may be a beneficial complement to treatments for some chronic diseases that yields no adverse effects. PMID:25716016

  7. Pharmacological therapy used in the elimination of Helicobacter pylori infection: a review.

    PubMed

    Dos Santos, Ariolana A; Carvalho, Adriana A

    2015-01-01

    The optimal therapy for Helicobacter pylori (H. pylori) infection should combine a high cure rate and a short treatment duration with a favorable side-effect profile and should maintain a low cost. Several strategies have been proposed to increase the H. pylori eradication rate, including the extension of the treatment duration to 14 d, the use of a four-drug regimen (quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as levofloxacin. However, triple therapy remains the most widely accepted first-line treatment regimen in Brazil and the United States and throughout Europe. Because this therapy is limited by resistance to clarithromycin, other therapeutic regimens have been investigated worldwide. This review describes the current literature involving studies directly comparing these different therapies and their efficacies. PMID:25574087

  8. Effectiveness of Solution-Focused Brief Therapy: A Systematic Qualitative Review of Controlled Outcome Studies

    ERIC Educational Resources Information Center

    Gingerich, Wallace J.; Peterson, Lance T.

    2013-01-01

    Objective: We review all available controlled outcome studies of solution-focused brief therapy (SFBT) to evaluate evidence of its effectiveness. Method: Forty-three studies were located and key data abstracted on problem, setting, SFBT intervention, design characteristics, and outcomes. Results: Thirty-two (74%) of the studies reported…

  9. Multisystemic Therapy for Child Non-Externalizing Psychological and Health Problems: A Preliminary Review

    ERIC Educational Resources Information Center

    Pane, Heather T.; White, Rachel S.; Nadorff, Michael R.; Grills-Taquechel, Amie; Stanley, Melinda A.

    2013-01-01

    Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors,…

  10. Child-Centered Play Therapy in the Schools: Review and Meta-Analysis

    ERIC Educational Resources Information Center

    Ray, Dee C.; Armstrong, Stephen A.; Balkin, Richard S.; Jayne, Kimberly M.

    2015-01-01

    The authors conducted a meta-analysis and systematic review that examined 23 studies evaluating the effectiveness of child centered play therapy (CCPT) conducted in elementary schools. Meta-analysis results were explored using a random effects model for mean difference and mean gain effect size estimates. Results revealed statistically significant…

  11. Concurrent or Sequential Hormonal and Radiation Therapy in Breast Cancer: A Literature Review

    PubMed Central

    Yu, Edward; Potvin, Kylea; D'souza, David; Lock, Michael

    2015-01-01

    Background and objectives: Adjuvant hormonal therapy is frequently used in the treatment of women with estrogen receptor (ER)/progesterone receptor (PR) positive breast cancer. When radiotherapy is given, hormone therapy may be delivered in a concurrent or sequential manner. Hormonal blockade with tamoxifen or aromatase inhibitors is thought to arrest hormonally dependent cancer cells in the early G1 phase of the cell cycle. This has been theorized to reduce the efficacy of radiation, which is known to be more effective in cells that are actively dividing. Therefore, there has been a reluctance by many to treat with concurrent hormonal and radiation therapy. Methods: We performed a search of the Medline database that led to the identification of 39 studies. Abstract and full-text review of these studies led to the identification of seven English non-review studies in peer-reviewed literature between 1995 and 2015 that addressed the question of timing of radiation and hormonal therapy. Outcome measures were captured from each of the studies. Results: No difference in survival or local-regional recurrence was identified between concurrent versus sequential treatment. Furthermore, no difference in cosmetic outcome or adverse effects was noted for either approach. However, when comparing radiation alone or radiation and hormonal therapy, there was an increased risk of breast and lung fibrosis with combined treatment. Conclusions: Hormone therapy, concurrent or sequential, with radiation results in comparable disease-related outcomes, including survival and recurrence. However, given the theoretical reduction in efficacy and increased rates of fibrosis with concurrent use, it is reasonable to support the use of sequential therapy.

  12. Boron analysis for neutron capture therapy using particle-induced gamma-ray emission.

    PubMed

    Nakai, Kei; Yamamoto, Yohei; Okamoto, Emiko; Yamamoto, Tetsuya; Yoshida, Fumiyo; Matsumura, Akira; Yamada, Naoto; Kitamura, Akane; Koka, Masashi; Satoh, Takahiro

    2015-12-01

    The neutron source of BNCT is currently changing from reactor to accelerator, but peripheral facilities such as a dose-planning system and blood boron analysis have still not been established. To evaluate the potential application of particle-induced gamma-ray emission (PIGE) for boron measurement in clinical boron neutron capture therapy, boronophenylalanine dissolved within a cell culture medium was measured using PIGE. PIGE detected 18?gB/mL f-BPA in the culture medium, and all measurements of any given sample were taken within 20min. Two hours of f-BPA exposure was required to create a boron distribution image. However, even though boron remained in the cells, the boron on the cell membrane could not be distinguished from the boron in the cytoplasm. PMID:26242558

  13. Design and characterization of an SRAM-based neutron detector for particle therapy

    NASA Astrophysics Data System (ADS)

    Ytre-Hauge, Kristian S.; Velure, Arild; Larsen, Eivind F.; Stokkevåg, Camilla H.; Röhrich, Dieter; Brekke, Njål; Odland, Odd Harald

    2015-12-01

    A neutron detector based on registration of radiation effects in Static Random Access Memories (SRAMs) has been developed at the University of Bergen for applications in particle therapy. Nine different SRAMs were tested and a 16 Mibit SRAM from Cypress was chosen for the final detector. The SRAMs were irradiated in beam lines at PTB Braunschweig, the Oslo Cyclotron Laboratory, The Svedberg Laboratory, The Institute for Energy Technology (IFE, Kjeller) and the CERN-EU high-energy reference field. The results from the measurements demonstrate the feasibility of using the selected SRAMs for neutron detection. The results indicate low or no sensitivity to thermal neutrons while the cross section for fast neutrons increases with neutron energy before reaching a more stable level at energies of several tenths of MeV.

  14. Surrogate-driven deformable motion model for organ motion tracking in particle radiation therapy

    NASA Astrophysics Data System (ADS)

    Fassi, Aurora; Seregni, Matteo; Riboldi, Marco; Cerveri, Pietro; Sarrut, David; Battista Ivaldi, Giovanni; Tabarelli de Fatis, Paola; Liotta, Marco; Baroni, Guido

    2015-02-01

    The aim of this study is the development and experimental testing of a tumor tracking method for particle radiation therapy, providing the daily respiratory dynamics of the patient’s thoraco-abdominal anatomy as a function of an external surface surrogate combined with an a priori motion model. The proposed tracking approach is based on a patient-specific breathing motion model, estimated from the four-dimensional (4D) planning computed tomography (CT) through deformable image registration. The model is adapted to the interfraction baseline variations in the patient’s anatomical configuration. The driving amplitude and phase parameters are obtained intrafractionally from a respiratory surrogate signal derived from the external surface displacement. The developed technique was assessed on a dataset of seven lung cancer patients, who underwent two repeated 4D CT scans. The first 4D CT was used to build the respiratory motion model, which was tested on the second scan. The geometric accuracy in localizing lung lesions, mediated over all breathing phases, ranged between 0.6 and 1.7?mm across all patients. Errors in tracking the surrounding organs at risk, such as lungs, trachea and esophagus, were lower than 1.3?mm on average. The median absolute variation in water equivalent path length (WEL) within the target volume did not exceed 1.9?mm-WEL for simulated particle beams. A significant improvement was achieved compared with error compensation based on standard rigid alignment. The present work can be regarded as a feasibility study for the potential extension of tumor tracking techniques in particle treatments. Differently from current tracking methods applied in conventional radiotherapy, the proposed approach allows for the dynamic localization of all anatomical structures scanned in the planning CT, thus providing complete information on density and WEL variations required for particle beam range adaptation.

  15. Surrogate-driven deformable motion model for organ motion tracking in particle radiation therapy.

    PubMed

    Fassi, Aurora; Seregni, Matteo; Riboldi, Marco; Cerveri, Pietro; Sarrut, David; Ivaldi, Giovanni Battista; de Fatis, Paola Tabarelli; Liotta, Marco; Baroni, Guido

    2015-02-21

    The aim of this study is the development and experimental testing of a tumor tracking method for particle radiation therapy, providing the daily respiratory dynamics of the patient's thoraco-abdominal anatomy as a function of an external surface surrogate combined with an a priori motion model. The proposed tracking approach is based on a patient-specific breathing motion model, estimated from the four-dimensional (4D) planning computed tomography (CT) through deformable image registration. The model is adapted to the interfraction baseline variations in the patient's anatomical configuration. The driving amplitude and phase parameters are obtained intrafractionally from a respiratory surrogate signal derived from the external surface displacement. The developed technique was assessed on a dataset of seven lung cancer patients, who underwent two repeated 4D CT scans. The first 4D CT was used to build the respiratory motion model, which was tested on the second scan. The geometric accuracy in localizing lung lesions, mediated over all breathing phases, ranged between 0.6 and 1.7?mm across all patients. Errors in tracking the surrounding organs at risk, such as lungs, trachea and esophagus, were lower than 1.3?mm on average. The median absolute variation in water equivalent path length (WEL) within the target volume did not exceed 1.9?mm-WEL for simulated particle beams. A significant improvement was achieved compared with error compensation based on standard rigid alignment. The present work can be regarded as a feasibility study for the potential extension of tumor tracking techniques in particle treatments. Differently from current tracking methods applied in conventional radiotherapy, the proposed approach allows for the dynamic localization of all anatomical structures scanned in the planning CT, thus providing complete information on density and WEL variations required for particle beam range adaptation. PMID:25615399

  16. Image guided particle therapy in CNAO room 2: implementation and clinical validation.

    PubMed

    Fattori, G; Riboldi, M; Pella, A; Peroni, M; Cerveri, P; Desplanques, M; Fontana, G; Tagaste, B; Valvo, F; Orecchia, R; Baroni, G

    2015-02-01

    In this contribution we describe the implementation of a novel solution for image guided particle therapy, designed to ensure the maximal accuracy in patient setup. The presented system is installed in the central treatment room at Centro Nazionale di Adroterapia Oncologica (CNAO, Italy), featuring two fixed beam lines (horizontal and vertical) for proton and carbon ion therapy. Treatment geometry verification is based on robotic in-room imaging acquisitions, allowing for 2D/3D registration from double planar kV-images or 3D/3D alignment from cone beam image reconstruction. The calculated six degrees-of-freedom correction vector is transferred to the robotic patient positioning system, thus yielding automated setup error compensation. Sub-millimetre scale residual errors were measured in absolute positioning of rigid phantoms, in agreement with optical- and laser-based assessment. Sub-millimetre and sub-degree positioning accuracy was achieved when simulating setup errors with anthropomorphic head, thorax and pelvis phantoms. The in-house design and development allowed a high level of system customization, capable of replicating the clinical performance of commercially available products, as reported with preliminary clinical results in 10 patients. PMID:25455440

  17. Dosimetric Considerations in Radioimmunotherapy and Systemic Radionuclide Therapies: A Review

    PubMed Central

    Loke, Kelvin S. H.; Padhy, Ajit K.; Ng, David C. E.; Goh, Anthony S.W.; Divgi, Chaitanya

    2011-01-01

    Radiopharmaceutical therapy, once touted as the “magic bullet” in radiation oncology, is increasingly being used in the treatment of a variety of malignancies; albeit in later disease stages. With ever-increasing public and medical awareness of radiation effects, radiation dosimetry is becoming more important. Dosimetry allows administration of the maximum tolerated radiation dose to the tumor/organ to be treated but limiting radiation to critical organs. Traditional tumor dosimetry involved acquiring pretherapy planar scans and plasma estimates with a diagnostic dose of intended radiopharmaceuticals. New advancements in single photon emission computed tomography and positron emission tomography systems allow semi-quantitative measurements of radiation dosimetry thus allowing treatments tailored to each individual patient. PMID:22144871

  18. Radiation biophysical aspects of charged particles: From the nanoscale to therapy

    NASA Astrophysics Data System (ADS)

    Scifoni, Emanuele

    2015-04-01

    Charged particle applications for radiotherapy are motivated by their specific advantages in terms of dose delivery and biological effect. These advantages have to a large extent originated from the peculiarities of ion beam energy deposition patterns in the medium on a microscopic, down to a nanoscopic scale. A large amount of research was conducted in this direction, especially in the last two decades, profiting also from the parallel investigations going on in radiation protection for space exploration. The main biophysical aspects of charged particles, which are relevant to hadrontherapy are shortly reviewed in the present contribution, namely focusing on relative biological effectiveness (RBE), oxygen enhancement ratio (OER) and combination with radiosensitizers. A summary of present major research direction on both microscopic and macroscopic assessment of the specific mechanism of radiation damage will be given, as well as several open challenges for a better understanding of the whole process, which still limit the full exploitation of ion beams for radiotherapy.

  19. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis

    PubMed Central

    2012-01-01

    Background Achilles tendinopathy (AT) is a common condition, causing considerable morbidity in athletes and non-athletes alike. Conservative or physical therapies are accepted as first-line management of AT; however, despite a growing volume of research, there remains a lack of high quality studies evaluating their efficacy. Previous systematic reviews provide preliminary evidence for non-surgical interventions for AT, but lack key quality components as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement. The aim of this study was to conduct a systematic review and meta-analysis (where possible) of the evidence for physical therapies for AT management. Methods A comprehensive strategy was used to search 11 electronic databases from inception to September 2011. Search terms included Achilles, tendinopathy, pain, physical therapies, electrotherapy and exercise (English language full-text publications, human studies). Reference lists of eligible papers were hand-searched. Randomised controlled trials (RCTs) were included if they evaluated at least one non-pharmacological, non-surgical intervention for AT using at least one outcome of pain and/or function. Two independent reviewers screened 2852 search results, identifying 23 suitable studies, and assessed methodological quality and risk of bias using a modified PEDro scale. Effect size calculation and meta-analyses were based on fixed and random effects models respectively. Results Methodological quality ranged from 2 to 12 (/14). Four studies were excluded due to high risk of bias, leaving 19 studies, the majority of which evaluated midportion AT. Effect sizes from individual RCTs support the use of eccentric exercise. Meta-analyses identified significant effects favouring the addition of laser therapy to eccentric exercise at 12?weeks (pain VAS: standardised mean difference ?0.59, 95% confidence interval ?1.11 to ?0.07), as well as no differences in effect between eccentric exercise and shock wave therapy at 16?weeks (VISA-A:–0.55,–2.21 to 1.11). Pooled data did not support the addition of night splints to eccentric exercise at 12?weeks (VISA-A:–0.35,–1.44 to 0.74). Limited evidence from an individual RCT suggests microcurrent therapy to be an effective intervention. Conclusions Practitioners can consider eccentric exercise as an initial intervention for AT, with the addition of laser therapy as appropriate. Shock wave therapy may represent an effective alternative. High-quality RCTs following CONSORT guidelines are required to further evaluate the efficacy of physical therapies and determine optimal clinical pathways for AT. PMID:22747701

  20. Triple therapy in type 2 diabetes; a systematic review and network meta-analysis

    PubMed Central

    Bettington, Emilie K.; Gunton, Jenny E.; Turkstra, Erika

    2015-01-01

    Aims. The purpose was to evaluate the evidence for triple therapy regimen using medicines available in Australia for type 2 diabetes. Methods. A systematic literature review was performed to update the relevant evidence from 2002 to 2014 on triple therapy for type 2 diabetes. A multiple-treatments network meta-analysis was undertaken to summarise the comparative efficacy and harms of different triple therapies. Results. Twenty seven trials were identified, most were six months of duration. The following combinations were included in the network meta-analysis: metformin (MET) + sulfonylureas (SU) (used as reference combination); MET + SU+ dipeptidyl peptidase 4 inhibitors (DPP-4-i); MET + SU+ thiazolidinediones (TZD); MET + SU+ glucagon-like peptide-1 receptor agonists (GLP-1-RA); MET + SU+ insulins; MET + TZD + DPP-4-i; and MET + SU+ sodium/glucose cotransporter 2 inhibitors (SGLT2-i). For HbA1c reduction, all triple therapies were statistically superior to MET+SU dual therapy, except for MET + TZD + DPP-4-i. None of the triple therapy combinations demonstrated differences in HbA1c compared with other triple therapies. MET + SU + SGLT2-i and MET + SU + GLP-1-RA resulted in significantly lower body weight than MET + SU + DPP-4-i, MET+SU+insulin and MET + SU + TZDs; MET + SU + DPP-4-i resulted in significantly lower body weight than MET + SU + insulin and MET + SU + TZD. MET + SU + insulin, MET + SU + TZD and MET + SU + DPP-4-i increased the odds of hypoglycaemia when compared to MET + SU. MET + SU + GLP-1-RA reduced the odds of hypoglycaemia compared to MET + SU + insulin. Conclusion. Care when choosing a triple therapy combination is needed as there is often a risk of increased hypoglycaemia events associated with this regimen and there are very limited data surrounding the long-term effectiveness and safety of combined therapies. PMID:26664803

  1. Particle Interaction Summary/Review Spring 2009 Compton Lecture Series

    E-print Network

    -particles ­ special relativity treats negative and positive energies the same, implies the existence of an infinite negative energy states are filled: the universe is full of negative energy particles ­ we define

  2. Production of [211At]-Astatinated Radiopharmaceuticals and Applications in Targeted ?-Particle Therapy

    PubMed Central

    Guérard, François; Gestin, Jean-François

    2013-01-01

    Abstract 211At is a promising radionuclide for ?-particle therapy of cancers. Its physical characteristics make this radionuclide particularly interesting to consider when bound to cancer-targeting biomolecules for the treatment of microscopic tumors. 211At is produced by cyclotron irradiation of 209Bi with ?-particles accelerated at ?28?MeV and can be obtained in high radionuclidic purity after isolation from the target. Its chemistry resembles iodine, but there is also a tendency to behave as a metalloid. However, the chemical behavior of astatine has not yet been clearly established, primarily due to the lack of any stable isotopes of this element, which precludes the use of conventional analytical techniques for its characterization. There are also only a limited number of research centers that have been able to produce this element in sufficient amounts to carry out extensive investigations. Despite these difficulties, chemical reactions typically used with iodine can be performed, and a number of biomolecules of interest have been labeled with 211At. However, most of these compounds exhibit unacceptable instability in vivo due to the weakness of the astatine–biomolecule bond. Nonetheless, several compounds have shown high potential for the treatment of cancers in vitro and in several animal models, thus providing a promising basis that has allowed initiation of the first two clinical studies. PMID:23075373

  3. Production of [(211)At]-astatinated radiopharmaceuticals and applications in targeted ?-particle therapy.

    PubMed

    Guérard, François; Gestin, Jean-François; Brechbiel, Martin W

    2013-02-01

    (211)At is a promising radionuclide for ?-particle therapy of cancers. Its physical characteristics make this radionuclide particularly interesting to consider when bound to cancer-targeting biomolecules for the treatment of microscopic tumors. (211)At is produced by cyclotron irradiation of (209)Bi with ?-particles accelerated at ~28 MeV and can be obtained in high radionuclidic purity after isolation from the target. Its chemistry resembles iodine, but there is also a tendency to behave as a metalloid. However, the chemical behavior of astatine has not yet been clearly established, primarily due to the lack of any stable isotopes of this element, which precludes the use of conventional analytical techniques for its characterization. There are also only a limited number of research centers that have been able to produce this element in sufficient amounts to carry out extensive investigations. Despite these difficulties, chemical reactions typically used with iodine can be performed, and a number of biomolecules of interest have been labeled with (211)At. However, most of these compounds exhibit unacceptable instability in vivo due to the weakness of the astatine-biomolecule bond. Nonetheless, several compounds have shown high potential for the treatment of cancers in vitro and in several animal models, thus providing a promising basis that has allowed initiation of the first two clinical studies. PMID:23075373

  4. Effect of Music Therapy on Postoperative Pain Management in Gynecological Patients: A Literature Review.

    PubMed

    Sin, Wai Man; Chow, Ka Ming

    2015-12-01

    Unrelieved postoperative pain may have a negative impact on the physiological and psychological well-being of patients. Pharmacological methods are currently used to relieve such pain in gynecological patients; however, inadequate pain control is still reported, and the use of nonpharmacological pain-relieving methods is increasingly being advocated, one of which is music therapy. The purpose of this literature review was to identify, summarize, and critically appraise current evidence on music therapy and postoperative pain management among gynecological patients. A systematic search of MEDLINE, CINAHL, PsycINFO, British Nursing Index, and Allied and Complementary Medicine was conducted using the search terms music, gynecological, pain, surgery, operative, and post-operative to identify relevant articles in English from 1995 to the present. All identified articles were assessed independently for inclusion into review. A total of 7 articles were included after removal of duplicates and exclusion of irrelevant studies. All the included studies assessed the effects of music therapy on postoperative pain intensity, and three of them measured pain-related physiological symptoms. The findings indicated that music therapy, in general, was effective in reducing pain intensity, fatigue, anxiety, and analgesic consumption in gynecological patients during the postoperative period. It is recommended as an adjunct to pharmacological pain-relieving methods in reducing postoperative pain. Future researches on music therapy to identify the most effective application and evaluate its effect by qualitative study are recommended. PMID:26697822

  5. Herbal therapy: A review of emerging pharmacological tools in the management of diabetes mellitus in Africa

    PubMed Central

    Kibiti, Cromwell Mwiti; Afolayan, Anthony Jide

    2015-01-01

    Background: Diabetes mellitus is a chronic physiological glucose metabolic disorder. It has affected millions of people all over the world thereby having a significant impact on quality of life. The management of diabetes includes both nonpharmacological and conventional interventions. Drawbacks in conventional therapy have led to seeking alternative therapy in herbal medicine. Therefore, the need to review, elucidate and classify their mode of action in therapy for diabetes disease arises. Materials and Methods: Comprehensive literature reports were used to review all conventional agents and herbal therapy used in the management of diabetes. An online database search was conducted for medicinal plants of African origin that have been investigated for their antidiabetic therapeutic potentials. Results: The results showed that of the documented sixty five plants used, fourteen inhibit intestinal absorption of glucose, three exhibit insulin-mimetic properties, seventeen stimulate insulin secretion from pancreatic beta cells, twelve enhance peripheral glucose uptake, one promotes regeneration of beta-cell of islets of Langerhans, thirteen ameliorate oxidative stress and twenty induces hypoglycemic effect (mode of action is still obscure). Thirteen of these plants have a duplicate mode of actions while one of them has three modes of actions. These agents have a similar mechanism of action as the conventional drugs. Conclusion: In conclusion, antidiabetic activities of these plants are well established; however, the molecular modulation remains unknown. It is envisaged that the use of herbal therapy will promote good health and improve the status of diabetic patients. PMID:26664014

  6. Hyperbaric oxygen therapy for treatment of children with autism: a systematic review of randomized trials

    PubMed Central

    2012-01-01

    There is a controversy about the efficacy of hyperbaric oxygen (HBO) therapy for the treatment of autism. This study systematically reviews the current evidences for treating of autism with HBO therapy. According to PRISMA guidelines for a systematic review, the databases of MEDLINE/Pubmed, Google Scholar, and Randomised Controlled Trials in Hyperbaric Medicine were electronically searched. In addition, medical subject heading terms and text words for hyperbaric oxygen therapy and autism were used. The main inclusion criteria were published studies which reported the original data from the trials conducted on the patients with autism and assessed outcomes with a valid and reliable instrument. A quality assessment was also conducted. The electronically search resulted in 18 title of publications. Two studies were randomized, double-blind, controlled-clinical trials. While some uncontrolled and controlled studies suggested that HBO therapy is effective for the treatment of autism, these promising effects are not replicated. Therefore, sham-controlled studies with rigorous methodology are required to be conducted in order to provide scientific evidence-based HBO therapy for autism treatment. PMID:22577817

  7. Takotsubo cardiomyopathy after electroconvulsive therapy: a case report and review.

    PubMed

    Celano, Christopher M; Torri, Andrea; Seiner, Stephen

    2011-09-01

    Takotsubo cardiomyopathy (TCM) is a syndrome of reversible stress-induced cardiomyopathy associated with profound emotional stress and a variety of medical illnesses and procedures, including electroconvulsive therapy (ECT). We describe 1 case of ECT-induced TCM followed by a successful retrial of ECT. We further discuss the management of ECT-induced TCM and the decision to perform a second trial of ECT in patients with this complication. Given the current understanding of the pathogenesis of TCM, it is appropriate to discontinue ECT during the acute setting of TCM. After the resolution of the acute episode of TCM, a second trial of ECT may be warranted depending on the severity of psychiatric illness (ie, suicidal ideation, catatonia, psychotic symptoms). If a retrial of ECT is performed, oral and intravenous ?-blockers should be used for cardioprotection, and patients should be monitored for signs and symptoms of an evolving cardiomyopathy. It is preferable to perform retrials of ECT-at least initially-in a general hospital setting, where immediate invasive monitoring and intensive treatments are available in the event of acute cardiac failure. PMID:21673587

  8. Convulsive therapy: a review of the first 55 years.

    PubMed

    Fink, M

    2001-03-01

    Convulsive therapy was introduced to psychiatric practice in 1934. It was widely hailed as an effective treatment for schizophrenia and quickly recognized as equally effective for the affective disorders. Like other somatic treatments, it was replaced by psychotropic drugs introduced in the 1950s and 1960s. But two decades later, ECT was recalled to treat pharmacotherapy-resistant cases. Avid searches to optimize seizure induction and treatment courses, to reduce risks and fears, to broaden the indications for its use, and to understand its mechanism of action followed. Unlike other medical treatments, however, these searches were severely impeded by a vigorous antipsychiatry movement among the public and within the profession. ECT is effective in the treatment of patients with major depression, delusional depression, bipolar disorder, schizophrenia, catatonia, neuroleptic malignant syndrome, and parkinsonism, and this breadth of action is both remarkable and unique. ECT is a safe treatment. No age or systemic condition bars its use. Its major limitations are the high relapse rates and the occasional profound effects on memory and recall that mar its success. Experiments to sustain its benefits with medications and with continuation ECT are underway. Its mode of action remains a mystery and this puzzle is an unappreciated challenge. The full impact of this intervention is yet to be felt. PMID:11246075

  9. Nutraceutical therapies for degenerative joint diseases: a critical review.

    PubMed

    Goggs, Robert; Vaughan-Thomas, Anne; Clegg, Peter D; Carter, Stuart D; Innes, John F; Mobasheri, Ali; Shakibaei, Mehdi; Schwab, Wolfgang; Bondy, Carolyn A

    2005-01-01

    There is growing recognition of the importance of nutritional factors in the maintenance of bone and joint health, and that nutritional imbalance combined with endocrine abnormalities may be involved in the pathogenesis of osteoarthritis (OA) and osteochondritis dissecans (OCD). Despite this, dietary programs have played a secondary role in the management of these connective tissue disorders. Articular cartilage is critically dependent upon the regular provision of nutrients (glucose and amino acids), vitamins (particularly vitamin C), and essential trace elements (zinc, magnesium, and copper). Therefore, dietary supplementation programs and nutraceuticals used in conjunction with non-steroidal, anti-inflammatory drugs (NSAIDs) may offer significant benefits to patients with joint disorders, such as OA and OCD. This article examines the available clinical evidence for the efficacy of nutraceuticals, antioxidant vitamin C, polyphenols, essential fatty acids, and mineral cofactors in the treatment of OA and related joint disorders in humans and veterinary species. This article also attempts to clarify the current state of knowledge. It also highlights the need for additional targeted research to elucidate the changes in nutritional status and potential alterations to the expression of plasma membrane transport systems in synovial structures in pathophysiological states, so that current therapy and future treatments may be better focused. PMID:16048146

  10. Review article: Nutritional therapy in alcoholic liver disease.

    PubMed

    Stickel, F; Hoehn, B; Schuppan, D; Seitz, H K

    2003-08-15

    Chronic alcohol consumption may lead to primary and secondary malnutrition. In particular, protein energy malnutrition not only aggravates alcoholic liver disease but also correlates with impaired liver function and increased mortality. Therefore, in these patients, adequate nutritional support should be implemented in order to improve their prognosis. Clinical trials addressing this issue have shown that nutritional therapy either enterally or parenterally improves various aspects of malnutrition, and there is increasing evidence that it may also improve survival. Therefore, malnourished alcoholics should be administered a diet rich in carbohydrate- and protein-derived calories preferentially via the oral or enteral route. Micronutrient deficiencies typically encountered in alcoholics, such as for thiamine and folate, require specific supplementation. Patients with hepatic encephalopathy may be treated with branched-chain amino acids in order to achieve a positive nitrogen balance. Fatty liver represents the early stage of alcoholic liver disease, which is usually reversible with abstinence. Metadoxine appears to improve fatty liver but confirmatory studies are necessary. S-adenosyl-L-methionine may be helpful for patients with severe alcoholic liver damage, since various mechanisms of alcohol-related hepatotoxicity are counteracted with this essential methyl group donor, while a recent large trial showed that the use of polyenylphosphatidylcholine is of limited efficacy. PMID:12940921

  11. Photodynamic therapy: a review of applications in neurooncology and neuropathology

    NASA Astrophysics Data System (ADS)

    Uzdensky, Anatoly B.; Berezhnaya, Elena; Kovaleva, Vera; Neginskaya, Marya; Rudkovskii, Mikhail; Sharifulina, Svetlana

    2015-06-01

    Photodynamic therapy (PDT) effect is a promising adjuvant modality for diagnosis and treatment of brain cancer. It is of importance that the bright fluorescence of most photosensitizers provides visualization of brain tumors. This is successfully used for fluorescence-guided tumor resection according to the principle "to see and to treat." Non-oncologic application of PDT effect for induction of photothrombotic infarct of the brain tissue is a well-controlled and reproducible stroke model, in which a local brain lesion is produced in the predetermined brain area. Since normal neurons and glial cells may also be damaged by PDT and this can lead to unwanted neurological consequences, PDT effects on normal neurons and glial cells should be comprehensively studied. We overviewed the current literature data on the PDT effect on a range of signaling and epigenetic proteins that control various cell functions, survival, necrosis, and apoptosis. We hypothesize that using cell-specific inhibitors or activators of some signaling proteins, one can selectively protect normal neurons and glia, and simultaneously exacerbate photodynamic damage of malignant gliomas.

  12. A challenge for theranostics: is the optimal particle for therapy also optimal for diagnostics?

    NASA Astrophysics Data System (ADS)

    Dreifuss, Tamar; Betzer, Oshra; Shilo, Malka; Popovtzer, Aron; Motiei, Menachem; Popovtzer, Rachela

    2015-09-01

    Theranostics is defined as the combination of therapeutic and diagnostic capabilities in the same agent. Nanotechnology is emerging as an efficient platform for theranostics, since nanoparticle-based contrast agents are powerful tools for enhancing in vivo imaging, while therapeutic nanoparticles may overcome several limitations of conventional drug delivery systems. Theranostic nanoparticles have drawn particular interest in cancer treatment, as they offer significant advantages over both common imaging contrast agents and chemotherapeutic drugs. However, the development of platforms for theranostic applications raises critical questions; is the optimal particle for therapy also the optimal particle for diagnostics? Are the specific characteristics needed to optimize diagnostic imaging parallel to those required for treatment applications? This issue is examined in the present study, by investigating the effect of the gold nanoparticle (GNP) size on tumor uptake and tumor imaging. A series of anti-epidermal growth factor receptor conjugated GNPs of different sizes (diameter range: 20-120 nm) was synthesized, and then their uptake by human squamous cell carcinoma head and neck cancer cells, in vitro and in vivo, as well as their tumor visualization capabilities were evaluated using CT. The results showed that the size of the nanoparticle plays an instrumental role in determining its potential activity in vivo. Interestingly, we found that although the highest tumor uptake was obtained with 20 nm C225-GNPs, the highest contrast enhancement in the tumor was obtained with 50 nm C225-GNPs, thus leading to the conclusion that the optimal particle size for drug delivery is not necessarily optimal for imaging. These findings stress the importance of the investigation and design of optimal nanoparticles for theranostic applications.Theranostics is defined as the combination of therapeutic and diagnostic capabilities in the same agent. Nanotechnology is emerging as an efficient platform for theranostics, since nanoparticle-based contrast agents are powerful tools for enhancing in vivo imaging, while therapeutic nanoparticles may overcome several limitations of conventional drug delivery systems. Theranostic nanoparticles have drawn particular interest in cancer treatment, as they offer significant advantages over both common imaging contrast agents and chemotherapeutic drugs. However, the development of platforms for theranostic applications raises critical questions; is the optimal particle for therapy also the optimal particle for diagnostics? Are the specific characteristics needed to optimize diagnostic imaging parallel to those required for treatment applications? This issue is examined in the present study, by investigating the effect of the gold nanoparticle (GNP) size on tumor uptake and tumor imaging. A series of anti-epidermal growth factor receptor conjugated GNPs of different sizes (diameter range: 20-120 nm) was synthesized, and then their uptake by human squamous cell carcinoma head and neck cancer cells, in vitro and in vivo, as well as their tumor visualization capabilities were evaluated using CT. The results showed that the size of the nanoparticle plays an instrumental role in determining its potential activity in vivo. Interestingly, we found that although the highest tumor uptake was obtained with 20 nm C225-GNPs, the highest contrast enhancement in the tumor was obtained with 50 nm C225-GNPs, thus leading to the conclusion that the optimal particle size for drug delivery is not necessarily optimal for imaging. These findings stress the importance of the investigation and design of optimal nanoparticles for theranostic applications. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr03119b

  13. A systematic review of dental disease in patients undergoing cancer therapy

    PubMed Central

    Napeñas, Joel J.; Hodgson, Brian D.; Stokman, Monique A.; Mathers-Stauffer, Vickie; Elting, Linda S.; Spijkervet, Fred K. L.; Brennan, Michael T.

    2010-01-01

    Introduction This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies. Review method A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies. Results Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n?=?457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n?=?189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n?=?162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%. Conclusions Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy. PMID:20449756

  14. Life-review therapy with computer supplements for depression in the elderly: a randomized controlled trial.

    PubMed

    Preschl, Barbara; Maercker, Andreas; Wagner, Birgit; Forstmeier, Simon; Baños, Rosa M; Alcañiz, Mariano; Castilla, Diana; Botella, Cristina

    2012-01-01

    Life-review therapy has been recognized as an effective therapeutic approach for depression in older adults. Additionally, the use of new media is becoming increasingly common in psychological interventions. The aim of this study was to investigate a life-review therapy in a face-to-face setting with additional computer use. This study explored whether a six-week life-review therapy with computer supplements from the e-mental health Butler system constitutes an effective approach to treat depression in older adults aged 65 and over. A total of 36 participants with elevated levels of depressive symptoms were randomized to a treatment group or a waiting-list control group and completed the post-assessment. Fourteen individuals in the intervention group completed the follow-up assessment. Analyses revealed significant changes from pre- to post-treatment or follow-up for depression, well-being, self-esteem, and obsessive reminiscence, but not for integrative reminiscence and life satisfaction. Depressive symptoms decreased significantly over time until the three-month follow-up in the intervention group compared to the control group (pre to post: d?=?1.13; pre to follow-up: d?=?1.27; and group?×?time effect pre to post: d?=?0.72). Furthermore, the therapy led to an increase in well-being and a decrease in obsessive reminiscence among the participants in the intervention group from pre-treatment to follow-up (well-being: d?=?0.70; obsessive reminiscence: d?=?0.93). Analyses further revealed a significant but small group?×?time effect regarding self-esteem (d?=?0.19). By and large, the results indicate that the life-review therapy in this combined setting could be recommended for depressive older adults. PMID:22788983

  15. Clinical review: Use of renal replacement therapies in special groups of ICU patients

    PubMed Central

    2012-01-01

    Acute kidney injury (AKI) in ICU patients is typically associated with other severe conditions that require special attention when renal replacement therapy (RRT) is performed. RRT includes a wide range of techniques, each with specific characteristics and implications for use in ICU patients. In the present review we discuss a wide range of conditions that can occur in ICU patients who have AKI, and the implications this has for RRT. Patients at increased risk for bleeding should be treated without anticoagulation or with regional citrate anticoagulation. In patients who are haemodynamically unstable, continuous therapies are most often employed. These therapies allow slow removal of volume and guarantee a stable blood pH. In patients with cerebral oedema, continuous therapy is recommended in order to prevent decreased cerebral blood flow, which will lead to cerebral ischemia. Continuous therapy will also prevent sudden change in serum osmolality with aggravation of cerebral oedema. Patients with hyponatraemia, as in liver failure or decompensated heart failure, require extra attention because a rapid increase of serum sodium concentration can lead to irreversible brain damage through osmotic myelinolysis. Finally, in patients with severe lactic acidosis, RRT can be used as a bridging therapy, awaiting correction of the underlying cause. Especially in ICU patients who have severe AKI, treatment with RRT requires balancing the pros and cons of different options and modalities. Exact and specific guidelines for RRT in these patients are not available for most clinical situations. In the present article we provide an update on the existing evidence. PMID:22264279

  16. Management and therapy of vasovagal syncope: A review

    PubMed Central

    Aydin, Muhammet Ali; Salukhe, Tushar V; Wilke, Iris; Willems, Stephan

    2010-01-01

    Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial. PMID:21160608

  17. Gene therapy for ocular diseases meditated by ultrasound and microbubbles (Review).

    PubMed

    Wan, Caifeng; Li, Fenghua; Li, Hongli

    2015-10-01

    The eye is an ideal target organ for gene therapy as it is easily accessible and immune?privileged. With the increasing insight into the underlying molecular mechanisms of ocular diseases, gene therapy has been proposed as an effective approach. Successful gene therapy depends on efficient gene transfer to targeted cells to prove stable and prolonged gene expression with minimal toxicity. At present, the main hindrance regarding the clinical application of gene therapy is not the lack of an ideal gene, but rather the lack of a safe and efficient method to selectively deliver genes to target cells and tissues. Ultrasound?targeted microbubble destruction (UTMD), with the advantages of high safety, repetitive applicability and tissue targeting, has become a potential strategy for gene? and drug delivery. When gene?loaded microbubbles are injected, UTMD is able to enhance the transport of the gene to the targeted cells. High?amplitude oscillations of microbubbles act as cavitation nuclei which can effectively focus ultrasound energy, produce oscillations and disruptions that increase the permeability of the cell membrane and create transient pores in the cell membrane. Thereby, the efficiency of gene therapy can be significantly improved. The UTMD?mediated gene delivery system has been widely used in pre?clinical studies to enhance gene expression in a site?specific manner in a variety of organs. With reasonable application, the effects of sonoporation can be spatially and temporally controlled to improve localized tissue deposition of gene complexes for ocular gene therapy applications. In addition, appropriately powered, focused ultrasound combined with microbubbles can induce a reversible disruption of the blood?retinal barrier with no significant side effects. The present review discusses the current status of gene therapy of ocular diseases as well as studies on gene therapy of ocular diseases meditated by UTMD. PMID:26151686

  18. Gene therapy for ocular diseases meditated by ultrasound and microbubbles (Review)

    PubMed Central

    WAN, CAIFENG; LI, FENGHUA; LI, HONGLI

    2015-01-01

    The eye is an ideal target organ for gene therapy as it is easily accessible and immune-privileged. With the increasing insight into the underlying molecular mechanisms of ocular diseases, gene therapy has been proposed as an effective approach. Successful gene therapy depends on efficient gene transfer to targeted cells to prove stable and prolonged gene expression with minimal toxicity. At present, the main hindrance regarding the clinical application of gene therapy is not the lack of an ideal gene, but rather the lack of a safe and efficient method to selectively deliver genes to target cells and tissues. Ultrasound-targeted microbubble destruction (UTMD), with the advantages of high safety, repetitive applicability and tissue targeting, has become a potential strategy for gene- and drug delivery. When gene-loaded microbubbles are injected, UTMD is able to enhance the transport of the gene to the targeted cells. High-amplitude oscillations of microbubbles act as cavitation nuclei which can effectively focus ultrasound energy, produce oscillations and disruptions that increase the permeability of the cell membrane and create transient pores in the cell membrane. Thereby, the efficiency of gene therapy can be significantly improved. The UTMD-mediated gene delivery system has been widely used in pre-clinical studies to enhance gene expression in a site-specific manner in a variety of organs. With reasonable application, the effects of sonoporation can be spatially and temporally controlled to improve localized tissue deposition of gene complexes for ocular gene therapy applications. In addition, appropriately powered, focused ultrasound combined with microbubbles can induce a reversible disruption of the blood-retinal barrier with no significant side effects. The present review discusses the current status of gene therapy of ocular diseases as well as studies on gene therapy of ocular diseases meditated by UTMD. PMID:26151686

  19. Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials

    PubMed Central

    Stuber, Kent; Kristmanson, Kevyn

    2006-01-01

    A narrative literature review of RCTs only, was conducted to ascertain which conservative treatments provide the best results for plantar fasciitis patients. Stretching, prefabricated and custom-made orthotics and night splints have all been scrutinized in numerous studies with mixed results. Chiropractic manipulative therapy has been examined in one study, with favorable results. Therapeutic ultrasound and low intensity laser therapy have been examined in one study apiece with unsatisfactory results. Based on the trials reviewed a trial of therapy beginning with low-cost, patient-centered treatments is recommended, particularly stretching, over-the-counter orthotics, and patient education. Several (but not all) of the reviewed articles indicated that custom-made orthoses are more beneficial for plantar fasciitis than over-the-counter orthotics. In the event these treatments do not provide satisfactory results, use of night splints should be considered. Based on this review, there is no support for the use of magnetic insoles for plantar fasciitis. Most of the studies were found to have at least one methodological flaw, including inadequate sample sizes, high drop-out rates, comparing multiple interventions to multiple interventions (thus making it difficult to determine the effect of each individual intervention) and lack of long-term follow-up. Outcome measure use between studies was inconsistent. PMID:17549177

  20. 4D particle therapy PET simulation for moving targets irradiated with scanned ion beams

    NASA Astrophysics Data System (ADS)

    Laube, K.; Menkel, S.; Bert, C.; Enghardt, W.; Helmbrecht, S.; Saito, N.; Fiedler, F.

    2013-02-01

    Particle therapy positron emission tomography (PT-PET) allows for an in vivo and in situ verification of applied dose distributions in ion beam therapy. Since the dose distribution cannot be extracted directly from the ?+-activity distribution gained from the PET scan the validation is done by means of a comparison between the reconstructed ?+-activity distributions from a PT-PET measurement and from a PT-PET simulation. Thus, the simulation software for generating PET data predicted from the treatment planning is an essential part of the dose verification routine. For the dose monitoring of intra-fractionally moving target volumes the PET data simulation needs to be upgraded by using time resolved (4D) algorithms to account correctly for the motion dependent displacement of the positron emitters. Moreover, it has to consider the time dependent relative movement between target volume and scanned beam to simulate the accurate positron emitter distribution generated during irradiation. Such a simulation program is presented which properly proceeds with motion compensated dose delivery by scanned ion beams to intra-fractionally moving targets. By means of a preclinical phantom study it is demonstrated that even the sophisticated motion-mitigated beam delivery technique of range compensated target tracking can be handled correctly by this simulation code. The new program is widely based on the 3D PT-PET simulation program which had been developed at the Helmholtz-Zentrum Dresden-Rossendorf, Germany (HZDR) for application within a pilot project to simulate in-beam PET data for about 440 patients with static tumor entities irradiated at the former treatment facility of the GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany (GSI). A simulation example for a phantom geometry irradiated with a tracked 12C-ion beam is presented for demonstrating the proper functionality of the program.

  1. Moving from Virtual Reality Exposure-Based Therapy to Augmented Reality Exposure-Based Therapy: A Review

    PubMed Central

    Baus, Oliver; Bouchard, Stéphane

    2014-01-01

    This paper reviews the move from virtual reality exposure-based therapy to augmented reality exposure-based therapy (ARET). Unlike virtual reality (VR), which entails a complete virtual environment (VE), augmented reality (AR) limits itself to producing certain virtual elements to then merge them into the view of the physical world. Although, the general public may only have become aware of AR in the last few years, AR type applications have been around since beginning of the twentieth century. Since, then, technological developments have enabled an ever increasing level of seamless integration of virtual and physical elements into one view. Like VR, AR allows the exposure to stimuli which, due to various reasons, may not be suitable for real-life scenarios. As such, AR has proven itself to be a medium through which individuals suffering from specific phobia can be exposed “safely” to the object(s) of their fear, without the costs associated with programing complete VEs. Thus, ARET can offer an efficacious alternative to some less advantageous exposure-based therapies. Above and beyond presenting what has been accomplished in ARET, this paper covers some less well-known aspects of the history of AR, raises some ARET related issues, and proposes potential avenues to be followed. These include the type of measures to be used to qualify the user’s experience in an augmented reality environment, the exclusion of certain AR-type functionalities from the definition of AR, as well as the potential use of ARET to treat non-small animal phobias, such as social phobia. PMID:24624073

  2. Breast cancer pain management - A review of current & novel therapies

    PubMed Central

    Satija, Aanchal; Ahmed, Syed Mehmood; Gupta, Rahul; Ahmed, Arif; Rana, Shiv Pratap Singh; Singh, Suraj Pal; Mishra, Seema; Bhatnagar, Sushma

    2014-01-01

    Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. PMID:24718395

  3. Antiviral therapy in chronic hepatitis E: a systematic review.

    PubMed

    Peters van Ton, A M; Gevers, T J G; Drenth, J P H

    2015-12-01

    Hepatitis E viral infection can lead to a chronic infection in immunocompromised patients, resulting in progressive liver disease and cirrhosis. Isolated cases have shown that treatment with ribavirin or pegylated interferon-? can result in viral eradication. This systematic review evaluated efficacy and safety of both treatments in chronic hepatitis E. A systematic literature search was performed on PubMed, Web of Science and clinicaltrials.gov for articles and abstracts. The keywords '"Hepatitis E" or HEV' AND 'ribavirin or Rebetol or Copegus' OR 'pegylated interferon OR peginterferon' were combined. The primary outcome was sustained viral response (SVR). Secondary endpoints include rapid viral response (RVR), relapse rates and side effects. Twenty-four studies matched our criteria, representing a total of 105 ribavirin-treated and 8 pegylated interferon-treated patients. The majority of patients had a solid organ transplant. Sixty-four per cent of ribavirin-treated patients achieved a SVR at 6 months after treatment cessation compared to 2/8 peginterferon-treated patients. Ribavirin was relatively well tolerated with the main side effect being anaemia, requiring dose reduction in 28% of patients. Peginterferon leads to acute transplant rejection in 2/8 patients. Ribavirin monotherapy appears to be an effective and safe treatment in all immunocompromised patients with chronic hepatitis E. The use of pegylated interferon in transplant patients may lead to transplant rejection and is not recommended. Therefore, ribavirin should be the antiviral treatment of choice in chronic hepatitis E. PMID:25760481

  4. Stem cell therapy – Hype or hope? A review

    PubMed Central

    Nadig, Roopa R

    2009-01-01

    While the regeneration of a lost tissue is known to mankind for several years, it is only in the recent past that research on regenerative medicine/dentistry has gained momentum and eluded the dramatic yet scientific advancements in the field of molecular biology. The growing understanding of biological concepts in the regeneration of oral/dental tissues coupled with experiments on stem cells is likely to result in a paradigm shift in the therapeutic armamentarium of dental and oral diseases culminating in an intense search for “biological solutions to biological problems.” Stem cells have been successfully isolated from variety of human tissues including orofacial tissues. Initial evidence from pioneering studies has documented the likely breakthrough that stem cells offer for various life-threatening diseases that have so far defeated modern medical care. The evidence gathered so far has propelled many elegant studies exploring the role of stem cells and their manifold dental applications. This review takes you on a sojourn of the origin of stem cells, their properties, characteristics, current research, and their potential applications. It also focuses on the various challenges and barriers that we have to surmount before translating laboratory results to successful clinical applications heralding the dawn of regenerative dentistry. PMID:20543921

  5. Mind-body therapies and control of inflammatory biology: A descriptive review.

    PubMed

    Bower, Julienne E; Irwin, Michael R

    2016-01-01

    The use of mind-body therapies, including Tai Chi, Qigong, yoga, and meditation, has grown steadily in recent years. These approaches have been shown to be effective in reducing symptoms and improving quality of life, and research has begun to examine the impact of these therapies on biological processes, including inflammation. A review of 26 randomized controlled trials was conducted to describe the effects of mind-body therapies (MBTs) on circulating, cellular, and genomic markers of inflammation. This qualitative evaluation showed mixed effects of MBTs on circulating inflammatory markers, including CRP and IL-6, and on measures of stimulated cytokine production. More consistent findings were seen for genomic markers, with trials showing decreased expression of inflammation-related genes and reduced signaling through the proinflammatory transcription factor NF-?B. Potential mechanisms for these effects are discussed, including alterations in neuroendocrine, neural, and psychological and behavioral processes. PMID:26116436

  6. Quality of life issues in men undergoing androgen deprivation therapy: a review

    PubMed Central

    Casey, Rowan G; Corcoran, Niall M; Larry Goldenberg, S

    2012-01-01

    Androgen deprivation therapy (ADT) has been an essential treatment option for treating prostate cancer (PCa). The role for hormonal treatment initially was restricted to men with metastatic and inoperable, locally advanced disease. Now it has been extended to neoadjuvant or adjuvant therapy for surgery and radiotherapy, for biochemical relapse after surgery or radiation, and even as primary therapy for non-metastatic disease. Fifty percent of PCa patients treated will receive ADT at some point. There is growing concern about the adverse effects and costs associated with more widespread ADT use. The adverse effects on quality of life (QoL), including physical, social and psychological well-being when men are androgen-deprived, may be considerable. This review examines the QoL issues in the following areas: body feminisation, sexual changes, relationship changes, cognitive and affective symptoms, fatigue, sleep disturbance, depression and physical effects. Further suggestions for therapeutic approaches to reduce these alterations are suggested. PMID:22231296

  7. Stem Cell Based Biological Pacemakers From Proof of Principle to Therapy: a Review

    PubMed Central

    Chauveau, Samuel; Brink, Peter R.; Cohen, Ira S.

    2014-01-01

    Electronic pacemakers are the standard therapy for bradycardia related symptoms but have shortcomings. Over the past 15 years experimental evidence has demonstrated that gene and cell-based therapies can create a biological pacemaker. Recently, physiologically acceptable rates have been reported with an adenovirus-based approach. But adenovirus-based protein expression does not last more than 4 weeks, which limits its clinical applicability. Cell-based platforms are potential candidates for longer expression. Currently there are two cell based approaches being tested: 1) Mesenchymal stem cells used as a suitcase for delivering pacemaker genes and 2) Pluripotent stem cells differentiated down a cardiac lineage with endogenous pacemaker activity. This review examines the current achievements in engineering a biological pacemaker, defines the patient population for whom this device would be useful and identifies the challenges still ahead before cell therapy can replace current electronic devices. PMID:24831844

  8. Mesenchymal stem cell therapy and acute graft-versus-host disease: a review.

    PubMed

    Amorin, Bruna; Alegretti, Ana Paula; Valim, Vanessa; Pezzi, Annelise; Laureano, Alvaro Macedo; da Silva, Maria Aparecida Lima; Wieck, Andréa; Silla, Lucia

    2014-10-01

    Mesenchymal stem cells (MSCs) are being widely studied as potential cell therapy agents due to their immunomodulatory properties, which have been established by in vitro studies and in several clinical trials. Within this context, mesenchymal stem cell therapy appears to hold substantial promise, particularly in the treatment of conditions involving autoimmune and inflammatory components. Nevertheless, many research findings are still contradictory, mostly due to difficulties in characterization of the effects of MSCs in vivo. The purpose of this review is to report the mechanisms underlying mesenchymal stem cell therapy for acute graft-versus-host disease, particularly with respect to immunomodulation, migration, and homing, as well as report clinical applications described in the literature. PMID:24903975

  9. Carcinoma of penis. Review of cases treated by surgery and radiation therapy 1960-1977

    SciTech Connect

    Krieg, R.M.; Luk, K.H.

    1981-08-01

    Cases of squamous cell carcinoma of the penis treated by surgery and radiation therapy at Moffitt Hospital, University of California, and Mount Zion Hospital and Medical Center are reviewed. Only cases followed for more than three years or with autopsy findings are presented. For the primary lesion, over-all surgical control rate locally was 15/17 or 88 per cent. Over-all control rate with radiation therapy alone was 9/12 (75 per cent), and with surgical salvage 11/12 (92 per cent). Radiation therapy appears to be the treatment of choice for early stage lesions, reserving surgery for salvage. Prophylactic ilioinguinal lymph node dissection for N0 lesions is not warranted. The role of chemotherapy needs further investigation.

  10. Stem cell-based biological pacemakers from proof of principle to therapy: a review.

    PubMed

    Chauveau, Samuel; Brink, Peter R; Cohen, Ira S

    2014-07-01

    Electronic pacemakers are the standard therapy for bradycardia-related symptoms but have shortcomings. Over the past 15 years, experimental evidence has demonstrated that gene and cell-based therapies can create a biological pacemaker. Recently, physiologically acceptable rates have been reported with an adenovirus-based approach. However, adenovirus-based protein expression does not last more than 4 weeks, which limits its clinical applicability. Cell-based platforms are potential candidates for longer expression. Currently there are two cell-based approaches being tested: (i) mesenchymal stem cells used as a suitcase for delivering pacemaker genes and (ii) pluripotent stem cells differentiated down a cardiac lineage with endogenous pacemaker activity. This review examines the current achievements in engineering a biological pacemaker, defines the patient population for whom this device would be useful and identifies the challenges still ahead before cell therapy can replace current electronic devices. PMID:24831844

  11. Systematic review of sensory integration therapy for individuals with disabilities: Single case design studies.

    PubMed

    Leong, H M; Carter, Mark; Stephenson, Jennifer

    2015-12-01

    Sensory integration therapy (SIT) is a controversial intervention that is widely used for people with disabilities. Systematic analysis was conducted on the outcomes of 17 single case design studies on sensory integration therapy for people with, or at-risk of, a developmental or learning disability, disorder or delay. An assessment of the quality of methodology of the studies found most used weak designs and poor methodology, with a tendency for higher quality studies to produce negative results. Based on limited comparative evidence, functional analysis-based interventions for challenging behavior were more effective that SIT. Overall the studies do not provide convincing evidence for the efficacy of sensory integration therapy. Given the findings of the present review and other recent analyses it is advised that the use of SIT be limited to experimental contexts. Issues with the studies and possible improvements for future research are discussed including the need to employ designs that allow for adequate demonstration of experimental control. PMID:26476485

  12. Automation and uncertainty analysis of a method for in-vivo range verification in particle therapy

    NASA Astrophysics Data System (ADS)

    Frey, K.; Unholtz, D.; Bauer, J.; Debus, J.; Min, C. H.; Bortfeld, T.; Paganetti, H.; Parodi, K.

    2014-10-01

    We introduce the automation of the range difference calculation deduced from particle-irradiation induced ?+-activity distributions with the so-called most-likely-shift approach, and evaluate its reliability via the monitoring of algorithm- and patient-specific uncertainty factors. The calculation of the range deviation is based on the minimization of the absolute profile differences in the distal part of two activity depth profiles shifted against each other. Depending on the workflow of positron emission tomography (PET)-based range verification, the two profiles under evaluation can correspond to measured and simulated distributions, or only measured data from different treatment sessions. In comparison to previous work, the proposed approach includes an automated identification of the distal region of interest for each pair of PET depth profiles and under consideration of the planned dose distribution, resulting in the optimal shift distance. Moreover, it introduces an estimate of uncertainty associated to the identified shift, which is then used as weighting factor to ‘red flag’ problematic large range differences. Furthermore, additional patient-specific uncertainty factors are calculated using available computed tomography (CT) data to support the range analysis. The performance of the new method for in-vivo treatment verification in the clinical routine is investigated with in-room PET images for proton therapy as well as with offline PET images for proton and carbon ion therapy. The comparison between measured PET activity distributions and predictions obtained by Monte Carlo simulations or measurements from previous treatment fractions is performed. For this purpose, a total of 15 patient datasets were analyzed, which were acquired at Massachusetts General Hospital and Heidelberg Ion-Beam Therapy Center with in-room PET and offline PET/CT scanners, respectively. Calculated range differences between the compared activity distributions are reported in a 2D map in beam-eye-view. In comparison to previously proposed approaches, the new most-likely-shift method shows more robust results for assessing in-vivo the range from strongly varying PET distributions caused by differing patient geometry, ion beam species, beam delivery techniques, PET imaging concepts and counting statistics. The additional visualization of the uncertainties and the dedicated weighting strategy contribute to the understanding of the reliability of observed range differences and the complexity in the prediction of activity distributions. The proposed method promises to offer a feasible technique for clinical routine of PET-based range verification.

  13. Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Li, Yan-hui; Wang, Feng-yun; Feng, Chun-qing; Yang, Xia-feng; Sun, Yi-hua

    2014-01-01

    Background Although some studies evaluated the effectiveness of massage therapy for fibromyalgia (FM), the role of massage therapy in the management of FM remained controversial. Objective The purpose of this systematic review is to evaluate the evidence of massage therapy for patients with FM. Methods Electronic databases (up to June 2013) were searched to identify relevant studies. The main outcome measures were pain, anxiety, depression, and sleep disturbance. Two reviewers independently abstracted data and appraised risk of bias. The risk of bias of eligible studies was assessed based on Cochrane tools. Standardised mean difference (SMD) and 95% confidence intervals (CI) were calculated by more conservative random-effects model. And heterogeneity was assessed based on the I2 statistic. Results Nine randomized controlled trials involving 404 patients met the inclusion criteria. The meta-analyses showed that massage therapy with duration ?5 weeks significantly improved pain (SMD, 0.62; 95% CI 0.05 to 1.20; p?=?0.03), anxiety (SMD, 0.44; 95% CI 0.09 to 0.78; p?=?0.01), and depression (SMD, 0.49; 95% CI 0.15 to 0.84; p?=?0.005) in patients with FM, but not on sleep disturbance (SMD, 0.19; 95% CI ?0.38 to 0.75; p?=?0.52). Conclusion Massage therapy with duration ?5 weeks had beneficial immediate effects on improving pain, anxiety, and depression in patients with FM. Massage therapy should be one of the viable complementary and alternative treatments for FM. However, given fewer eligible studies in subgroup meta-analyses and no evidence on follow-up effects, large-scale randomized controlled trials with long follow-up are warrant to confirm the current findings. PMID:24586677

  14. Review of Occupational Therapy Research in the Practice Area of Children and Youth

    PubMed Central

    Bendixen, Roxanna M.; Kreider, Consuelo M.

    2011-01-01

    A systematic review was conducted focusing on articles in the Occupational Therapy (OT) practice category of Childhood and Youth (C&Y) published in the American Journal of Occupational Therapy (AJOT) over the two-year period of 2009–2010. The frameworks of the International Classification of Functioning, Disability and Health (ICF) and Positive Youth Development (PYD) were used to explore OT research progress toward the goals of the Centennial Vision (CV). Forty-six research articles were organized by research type and were classified within these two frameworks. The majority of reviewed published research investigated variables representing constructs falling within the ICF domains of Body Functioning and Activity. The effect of OT interventions on PYD resided primarily in building competence. In order to meet the tenets of the CV, OTs must document changes in children’s engagement in everyday life situations and build the evidence of OT’s efficacy in facilitating participation. PMID:21675342

  15. A review of "music and movement" therapies for children with autism: embodied interventions for multisystem development.

    PubMed

    Srinivasan, Sudha M; Bhat, Anjana N

    2013-01-01

    The rising incidence of Autism Spectrum Disorders (ASDs) has led to a surge in the number of children needing autism interventions. This paper is a call to clinicians to diversify autism interventions and to promote the use of embodied music-based approaches to facilitate multisystem development. Approximately 12% of all autism interventions and 45% of all alternative treatment strategies in schools involve music-based activities. Musical training impacts various forms of development including communication, social-emotional, and motor development in children with ASDs and other developmental disorders as well as typically developing children. In this review, we will highlight the multisystem impairments of ASDs, explain why music and movement therapies are a powerful clinical tool, as well as describe mechanisms and offer evidence in support of music therapies for children with ASDs. We will support our claims by reviewing results from brain imaging studies reporting on music therapy effects in children with autism. We will also discuss the critical elements and the different types of music therapy approaches commonly used in pediatric neurological populations including autism. We provide strong arguments for the use of music and movement interventions as a multisystem treatment tool for children with ASDs. Finally, we also make recommendations for assessment and treatment of children with ASDs, and provide directions for future research. PMID:23576962

  16. A review of “music and movement” therapies for children with autism: embodied interventions for multisystem development

    PubMed Central

    Srinivasan, Sudha M.; Bhat, Anjana N.

    2013-01-01

    The rising incidence of Autism Spectrum Disorders (ASDs) has led to a surge in the number of children needing autism interventions. This paper is a call to clinicians to diversify autism interventions and to promote the use of embodied music-based approaches to facilitate multisystem development. Approximately 12% of all autism interventions and 45% of all alternative treatment strategies in schools involve music-based activities. Musical training impacts various forms of development including communication, social-emotional, and motor development in children with ASDs and other developmental disorders as well as typically developing children. In this review, we will highlight the multisystem impairments of ASDs, explain why music and movement therapies are a powerful clinical tool, as well as describe mechanisms and offer evidence in support of music therapies for children with ASDs. We will support our claims by reviewing results from brain imaging studies reporting on music therapy effects in children with autism. We will also discuss the critical elements and the different types of music therapy approaches commonly used in pediatric neurological populations including autism. We provide strong arguments for the use of music and movement interventions as a multisystem treatment tool for children with ASDs. Finally, we also make recommendations for assessment and treatment of children with ASDs, and provide directions for future research. PMID:23576962

  17. Music therapy for service users with dementia: a critical review of the literature.

    PubMed

    Blackburn, R; Bradshaw, T

    2014-12-01

    Dementia is an organic mental health problem that has been estimated to affect over 23 million people worldwide. With increasing life expectancy in most countries, it has been estimated that the prevalence of dementia will continue to significantly increase in the next two decades. Dementia leads to cognitive impairments most notably short-term memory loss and impairments in functioning and quality of life (QOL). National policy in the UK advocates the importance of early diagnosis, treatment and social inclusion in maintaining a good QOL. First-line treatment options often involve drug therapies aimed at slowing down the progression of the illness and antipsychotic medication to address challenging behaviours. To date, research into non-pharmacological interventions has been limited. In this manuscript, we review the literature that has reported evaluations of the effects of music therapy, a non-pharmacological intervention. The results of six studies reviewed suggest that music therapy may have potential benefits in reducing anxiety, depression and agitated behaviour displayed by elderly people with dementia as well as improving cognitive functioning and QOL. Furthermore, music therapy is a safe and low-cost intervention that could potentially be offered by mental health nurses and other carers working in residential settings. PMID:25303405

  18. REPETITIVE TASK PRACTICE: A CRITICAL REVIEW OF CONSTRAINT-INDUCED MOVEMENT THERAPY IN STROKE

    PubMed Central

    Wolf, Steven L.; Blanton, Sarah; Baer, Heather; Breshears, Jenifer; Butler, Andrew J.

    2013-01-01

    BACKGROUND Constraint-induced (CI) movement therapy (also called forced use by some investigators and clinicians) has gained increasing popularity as a treatment mode for restoring function in the upper extremities of patients with stroke. The purpose of this article is to review the concept of constraint-induced movement therapy and provide a critical analysis of the existing data. REVIEW SUMMARY The evidence to date offers encouragement for the application of this procedure for patients who have some movement recovery out of synergy. Success may be contingent on patient cooperation and intense repetitive use with applications of retraining through practice and shaping. The extent to which each of the latter elements influences the magnitude of recovery is still unclear. However, task novelty and challenge seem important to recovery of function. There are several methods used to map cortical changes after stroke. At this time, transcranial magnetic stimulation is the primary vehicle used to assess motor cortical reorganization after CI therapy in humans. CONCLUSIONS Accumulating data indicate that the size of a cortical area representative of a muscle does expand and its center of gravity does change with CI therapy. PMID:12801434

  19. One-step synthesis of gradient gadolinium ironhexacyanoferrate nanoparticles: a new particle design easily combining MRI contrast and photothermal therapy

    NASA Astrophysics Data System (ADS)

    Li, Yichen; Li, Carissa H.; Talham, Daniel R.

    2015-03-01

    A one-step synthesis of Prussian blue nanoparticles possessing a concentration gradient of Gd3+ counterions, g-Gd-PB, has been developed, and the potential for the particles to perform as both MRI positive contrast agents and photothermal therapy agents is demonstrated. The synthesis of potassium/gadolinium ironhexacyanoferrate is performed under increasing concentration of Gd3+ ions forming particles with a higher concentration of gadolinium toward the outer layers. The proton relaxivity (r1) measured for the particles is 12.3 mM-1 s-1, and T1 weighted images of phantoms containing the particles show their potential as MRI contrast agents. In addition, the Prussian blue host can rapidly and efficiently convert energy from near-IR light into thermal energy, allowing g-Gd-PB to be used as a photothermal therapy agent. The photothermal properties are demonstrated by measuring temperature changes of particle suspensions under irradiation and by photothermal ablation of CCRF-CEM cancer cells.A one-step synthesis of Prussian blue nanoparticles possessing a concentration gradient of Gd3+ counterions, g-Gd-PB, has been developed, and the potential for the particles to perform as both MRI positive contrast agents and photothermal therapy agents is demonstrated. The synthesis of potassium/gadolinium ironhexacyanoferrate is performed under increasing concentration of Gd3+ ions forming particles with a higher concentration of gadolinium toward the outer layers. The proton relaxivity (r1) measured for the particles is 12.3 mM-1 s-1, and T1 weighted images of phantoms containing the particles show their potential as MRI contrast agents. In addition, the Prussian blue host can rapidly and efficiently convert energy from near-IR light into thermal energy, allowing g-Gd-PB to be used as a photothermal therapy agent. The photothermal properties are demonstrated by measuring temperature changes of particle suspensions under irradiation and by photothermal ablation of CCRF-CEM cancer cells. Electronic supplementary information (ESI) available. See DOI: 10.1039/c4nr06481j

  20. A review of gene therapy in canine and feline models of lysosomal storage disorders.

    PubMed

    Bradbury, Allison M; Gurda, Brittney L; Casal, Margret L; Ponder, Katherine P; Vite, Charles H; Haskins, Mark E

    2015-03-01

    Lysosomal storage disorders (LSDs) are inherited diseases that result from the intracellular accumulation of incompletely degraded macromolecules. The majority of LSDs affect both the peripheral and central nervous systems and are not effectively treated by enzyme replacement therapy, substrate reduction therapy, or bone marrow transplantation. Advances in adeno-associated virus and retroviral vector development over the past decade have resurged gene therapy as a promising therapeutic intervention for these monogenic diseases. Animal models of LSDs provide a necessary intermediate to optimize gene therapy protocols and assess the safety and efficacy of treatment prior to initiating human clinical trials. Numerous LSDs are naturally occurring in large animal models and closely reiterate the lesions, biochemical defect, and clinical phenotype observed in human patients, and whose lifetime is sufficiently long to assess the effect on symptoms that develop later in life. Herein, we review that gene therapy in large animal models (dogs and cats) of LSDs improved many manifestations of disease, and may be used in patients in the near future. PMID:25671613

  1. Efficacy of Auricular Therapy for Pain Management: A Systematic Review and Meta-Analysis

    PubMed Central

    Yeh, Chao Hsing; Chiang, Yi Chien; Hoffman, Samuel L.; Liang, Zhan; Klem, Mary Lou; Tam, Wilson W. S.; Chien, Lung-Chang; Suen, Lorna Kwai-Ping

    2014-01-01

    Objective. The objective of this systematic review and meta-analysis was to assess the efficacy of auricular therapy by including a sham therapy control group. Methods. Relevant, randomized clinical trials (RCTs) were identified by searching medical related databases from, depending on journal, 1900 (at the earliest) to 1994 (at the latest) through May 2013. The outcome measure was a pain intensity score. Results. Twenty-two RCTs were identified and 13 RCTs were included for meta-analysis. In these studies, auricular therapy provided significant pain relief when compared to a sham or control group. The overall standardized mean differences (SMD) was 1.59 (95% CI [?2.36, ?0.82]) (13 trials, total subject numbers = 806), indicating that, on average, the mean decrease in pain score for auricular therapy group was 1.59 standard deviations greater than the mean decrease for the sham control. In terms of the efficacy of the different treatment methods, auricular acupressure boasts the largest strength of evidence for pain relief, followed by auricular acupuncture. Electroacupuncture stimulation did not show significant evidence for efficacy, which may be due to the small sample size (i.e., only 19 subjects were included). Conclusion. Further large-scale RCTs are needed to determine the efficacy of auricular therapy for pain. PMID:25165482

  2. Management of adverse events in the treatment of patients with immunoglobulin therapy: A review of evidence.

    PubMed

    Cherin, Patrick; Marie, Isabelle; Michallet, Mauricette; Pelus, Eric; Dantal, Jacques; Crave, Jean-Charles; Delain, Jean-Christophe; Viallard, Jean-François

    2016-01-01

    Immunoglobulin (IG) therapy is actually used for a broad range of diseases including primary and secondary immunodeficiency disorders, and autoimmune diseases. This therapy is available for intravenous (IV) and subcutaneous (SC) administration. The efficacy of the IG therapy has been demonstrated in numerous studies and across different diseases. Generally, IG infusions are well tolerated; however some well-known adverse reactions, ranging from mild to severe, are associated with the therapy. The most common adverse reactions including headache, nausea, myalgia, fever, chills, chest discomfort, skin and anaphylactic reactions, could arise immediately during or after the infusion. Delayed events could be more severe and include migraine headaches, aseptic meningitis, haemolysis renal impairment and thrombotic events. This paper reviews all the potential adverse events related to IG therapy and establishes a comprehensive guideline for the management of these events. Moreover it resumes the opinions and clinical experience of expert endorsers on the utilization of the treatment. Published data were classified into levels of evidence and the strength of the recommendation was given for each intervention according to the GRADE system. PMID:26384525

  3. Adrenal Function Testing Following Hormone Therapy for Infantile Spasms: Case Series and Review of Literature

    PubMed Central

    Mytinger, John R.; Bowden, Sasigarn A.

    2015-01-01

    Prednisolone and adrenocorticotropic hormone (ACTH) are “hormone” therapies for infantile spasms. There is limited data on the occurrence of decreased adrenal reserve or signs of clinical adrenal insufficiency after hormone therapy. This is a retrospective medical record review of patients referred to our Infantile Spasms Program. Our standardized infantile spasms management guideline began in September 2012 and initially included a post-hormone laboratory assessment of adrenal function. Medical records were assessed for hormone treatments, adrenal function testing, and signs of adrenal insufficiency. Forty-two patients who received one or both hormone therapies met inclusion criteria. A post-hormone laboratory assessment of adrenal function was done in 14 patients. Of these 14 patients, 2 had an abnormal laboratory assessment of adrenal function, both by adrenal stimulation testing?–?one after ACTH and one after prednisolone. One patient received hydrocortisone replacement and the other received stress dose hydrocortisone as needed; neither patient developed signs of adrenal insufficiency. Another patient treated with both types of hormone therapy in tandem, who did not have a post-hormone laboratory assessment, developed signs of mild adrenal insufficiency and required replacement hydrocortisone. Our study suggests that adrenal suppression can occur after modern hormone therapy regimens. We found two patients with abnormal adrenal function testing after hormone therapy and another patient with signs adrenal insufficiency. Given the seriousness of adrenal crisis, caregiver education on the signs of adrenal insufficiency is critical. Greater vigilance may be indicated in patients receiving both types of hormone therapy in tandem. Although a routine post-hormone laboratory assessment of adrenal function may not be feasible in all patients, replacement or stress dose hydrocortisone is necessary for all patients with suspected adrenal insufficiency. PMID:26696958

  4. Adjuvant endocrine therapy for early breast cancer: a systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline

    PubMed Central

    Freedman, O.C.; Fletcher, G.G.; Gandhi, S.; Mates, M.; Dent, S.F.; Trudeau, M.E.; Eisen, A.

    2015-01-01

    Background Cancer Care Ontario’s Program in Evidence-Based Care (pebc) recently created an evidence-based consensus guideline on the systemic treatment of early breast cancer. The evidence for the guideline was compiled using a systematic review to answer the question “What is the optimal systemic therapy for patients with early-stage, operable breast cancer, when patient and disease factors are considered?” The question was addressed in three parts: cytotoxic chemotherapy, endocrine treatment, and her2 (human epidermal growth factor receptor 2)–targeted therapy. Methods For the systematic review, the literature in the medline and embase databases was searched for the period January 2008 to May 2014. The Standards and Guidelines Evidence directory of cancer guidelines and the Web sites of major oncology guideline organizations were also searched. The basic search terms were “breast cancer” and “systemic therapy” (chemotherapy, endocrine therapy, targeted agents, ovarian suppression), and results were limited to randomized controlled trials (rcts), guidelines, systematic reviews, and meta-analyses. Results Several hundred documents that met the inclusion criteria were retrieved. Meta-analyses from the Early Breast Cancer Trialists’ Collaborative Group encompassed many of the rcts found. Several additional studies that met the inclusion criteria were retained, as were other guidelines and systematic reviews. Summary The results of the systematic review constitute a comprehensive compilation of high-level evidence, which was the basis for the 2014 pebc guideline on systemic therapy for early breast cancer. The review of the evidence for systemic endocrine therapy (adjuvant tamoxifen, aromatase inhibitors, and ovarian ablation and suppression) is presented here; the evidence for chemotherapy and her2-targeted treatment—and the final clinical practice recommendations—are presented separately in this supplement. PMID:25848344

  5. The Effectiveness of Community-Based Occupational Therapy Education and Functional Training Programs for Older Adults: A Critical Literature Review.

    ERIC Educational Resources Information Center

    Wilkins, Seanne; Jung, Bonny; Wishart, Laurie; Edwards, Mary; Norton, Shelley Gamble

    2003-01-01

    Results of a literature review describing the provision of education and occupational therapy training programs for older adults indicate that programs are effective in three areas: prevention of functional decline and falls, stroke, and rheumatoid arthritis. (Contains 37 references.) (JOW)

  6. Black holes as particle accelerators: a brief review

    E-print Network

    Tomohiro Harada; Masashi Kimura

    2014-11-18

    Rapidly rotating Kerr black holes can accelerate particles to arbitrarily high energy if the angular momentum of the particle is fine-tuned to some critical value. This phenomenon is robust as it is founded on the basic properties of geodesic orbits around a near-extremal Kerr black hole. On the other hand, the maximum energy of the acceleration is subjected to several physical effects. There is convincing evidence that the particle acceleration to arbitrarily high energy is one of the universal properties of general near-extremal black holes. We also discuss gravitational particle acceleration in more general context. This article is intended to provide a pedagogical introduction to and a brief overview of this topic for non-specialists.

  7. A review of electron bombardment thruster systems/spacecraft field and particle interfaces

    NASA Technical Reports Server (NTRS)

    Byers, D. C.

    1978-01-01

    Information on the field and particle interfaces of electron bombardment ion thruster systems was summarized. Major areas discussed were the nonpropellant particles, neutral propellant, ion beam, low energy plasma, and fields. Spacecraft functions and subsystems reviewed were solar arrays, thermal control systems, optical sensors, communications, science, structures and materials, and potential control.

  8. EXPERIMENTAL INVESTIGATIONS OF FINE PARTICLE CHARGING BY UNIPOLAR IONS: A REVIEW

    EPA Science Inventory

    The paper gives results of a study relating experimental data to many theories that have been offered in attempts to describe accurately the rate of charge accumulation of fine particles in a unipolar field. The data are reviewed and compiled, and additional particle charging exp...

  9. Risk Associated with Bee Venom Therapy: A Systematic Review and Meta-Analysis

    PubMed Central

    Park, Jeong Hwan; Yim, Bo Kyung; Lee, Jun-Hwan; Lee, Sanghun; Kim, Tae-Hun

    2015-01-01

    Objective The safety of bee venom as a therapeutic compound has been extensively studied, resulting in the identification of potential adverse events, which range from trivial skin reactions that usually resolve over several days to life-threating severe immunological responses such as anaphylaxis. In this systematic review, we provide a summary of the types and prevalence of adverse events associated with bee venom therapy. Methods We searched the literature using 12 databases from their inception to June 2014, without language restrictions. We included all types of clinical studies in which bee venom was used as a key intervention and adverse events that may have been causally related to bee venom therapy were reported. Results A total of 145 studies, including 20 randomized controlled trials, 79 audits and cohort studies, 33 single-case studies, and 13 case series, were evaluated in this review. The median frequency of patients who experienced adverse events related to venom immunotherapy was 28.87% (interquartile range, 14.57–39.74) in the audit studies. Compared with normal saline injection, bee venom acupuncture showed a 261% increased relative risk for the occurrence of adverse events (relative risk, 3.61; 95% confidence interval, 2.10 to 6.20) in the randomized controlled trials, which might be overestimated or underestimated owing to the poor reporting quality of the included studies. Conclusions Adverse events related to bee venom therapy are frequent; therefore, practitioners of bee venom therapy should be cautious when applying it in daily clinical practice, and the practitioner’s education and qualifications regarding the use of bee venom therapy should be ensured. PMID:25996493

  10. Clinical- and cost-effectiveness of LDL particle-guided statin therapy: a simulation study.

    PubMed

    Folse, Henry J; Goswami, Devesh; Rengarajan, Badri; Budoff, Matthew; Kahn, Richard

    2014-09-01

    We used the Archimedes Model, a mathematical simulation model (Model) to estimate the clinical- and cost-effectiveness of using LDL particle concentration (LDL-P) as an adjunct or alternative to LDL cholesterol (LDL-C) to guide statin therapy. LDL-P by NMR has been shown to be a better measure of cardiovascular disease (CVD) risk than LDL-C, and may therefore be a better gauge of the need for and response to statin treatment. Using the Model, we conducted a virtual clinical trial comparing the use of LDL-C alone, LDL-P alone, and LDL-C and LDL-P together to guide treatment in the general adult population, and in high-risk, dyslipidemic subpopulations. In the general population, the 5-year major adverse cardiovascular event (MACE) relative risk reduction (RRR) of LDL-P alone compared to the control arm (LDL-C alone) was 5.0% (95% CI, 4.7-5.3; p < .0001); using both LDL-C and LDL-P (dual markers) led to 3.0% RRR compared to the control arm (95% CI, 2.8-3.3; p < .0001). For individuals with diabetes, the RRR was 7.3% (95% CI, 6.4-8.2; p < .0001) for LDL-P alone and 6.9% for dual markers (95% CI, 6.1-7.8; both, p < .0001). In the general population, the costs per quality-adjusted life year (QALY) associated with the use of LDL-P alone were $76,052 at 5 years and $8913 at 20 years and $142,825 at 5 years and $25,505 at 20 years with the use of both markers. In high-risk subpopulations, the use of LDL-P alone was cost-saving at 5 years; whereas the cost per QALY for the use of both markers was $14,250 at 5 years and $859 at 20 years for high-risk dyslipidemics, $19,192 at 5 years and $649 at 20 years for diabetics, and $9030 at 5 years and $7268 at 20 years for patients with prior CHD. In conclusion, the model estimates that using LDL-P to guide statin therapy may reduce the risk of CVD events to a greater extent than does the use of LDL-C alone and maybe cost-effective or cost-saving for high-risk patients. PMID:25050538

  11. Lenalidomide in multiple myeloma: an evidence-based review of its role in therapy

    PubMed Central

    Richardson, Paul; Mitsiades, Constantine; Laubach, Jacob; Schlossman, Robert; Ghobrial, Irene; Hideshima, Teru; Munshi, Nikhil; Anderson, Kenneth

    2010-01-01

    Introduction: Multiple myeloma (MM) is a relatively common and incurable hematological malignancy. Currently, there is no single standard therapy, with choice of treatment dependent on individual patient factors. Lenalidomide is an immunomodulatory drug with potent antitumor, antiangiogenic, immunomodulatory, and proapoptotic activity in MM. Aims: To evaluate the evidence for the use of lenalidomide in its current indication in relapsed or refractory MM, and additionally its investigational use for the treatment of newly diagnosed MM. Evidence review: In patients with relapsed and refractory MM, adding lenalidomide to high-dose dexamethasone significantly improves response rates and time-to-progression, relative to high-dose dexamethasone alone. This translates into a significant extension of overall survival (with a median extension of 9.1 months in a pivotal phase III study). Outcome is independent of patient age, number of previous therapies, type of previous therapy (including thalidomide or autologous stem cell transplantation), renal impairment, and ?2-microglobulin level. Evidence suggests that combining lenalidomide with low-dose dexamethasone improves outcomes in patients with newly diagnosed disease and is superior to lenalidomide combined with high-dose dexamethasone. Myelosuppression is the predominant toxicity observed, although some studies have shown high incidences of venous thromboembolism in the absence of prophylactic antithrombotic anticoagulation therapy. There is currently only limited evidence regarding the health economics of lenalidomide. Role in therapy: The encouraging results obtained with lenalidomide alone and in combination with dexamethasone in patients with relapsed or refractory MM have led to its adoption as a recommended therapy in patients who have received at least one prior treatment. Emerging evidence supports the ongoing investigation of lenalidomide in combination with low-dose dexamethasone, and in other combinations including bortezomib, for use both in relapsed, refractory, and newly diagnosed MM. PMID:20694078

  12. Concise review: workshop review: understanding and assessing the risks of stem cell-based therapies.

    PubMed

    Heslop, James A; Hammond, Thomas G; Santeramo, Ilaria; Tort Piella, Agnès; Hopp, Isabel; Zhou, Jing; Baty, Roua; Graziano, Enrique I; Proto Marco, Bernabé; Caron, Alexis; Sköld, Patrik; Andrews, Peter W; Baxter, Melissa A; Hay, David C; Hamdam, Junnat; Sharpe, Michaela E; Patel, Sara; Jones, David R; Reinhardt, Jens; Danen, Erik H J; Ben-David, Uri; Stacey, Glyn; Björquist, Petter; Piner, Jacqueline; Mills, John; Rowe, Cliff; Pellegrini, Giovanni; Sethu, Swaminathan; Antoine, Daniel J; Cross, Michael J; Murray, Patricia; Williams, Dominic P; Kitteringham, Neil R; Goldring, Chris E P; Park, B Kevin

    2015-04-01

    The field of stem cell therapeutics is moving ever closer to widespread application in the clinic. However, despite the undoubted potential held by these therapies, the balance between risk and benefit remains difficult to predict. As in any new field, a lack of previous application in man and gaps in the underlying science mean that regulators and investigators continue to look for a balance between minimizing potential risk and ensuring therapies are not needlessly kept from patients. Here, we attempt to identify the important safety issues, assessing the current advances in scientific knowledge and how they may translate to clinical therapeutic strategies in the identification and management of these risks. We also investigate the tools and techniques currently available to researchers during preclinical and clinical development of stem cell products, their utility and limitations, and how these tools may be strategically used in the development of these therapies. We conclude that ensuring safety through cutting-edge science and robust assays, coupled with regular and open discussions between regulators and academic/industrial investigators, is likely to prove the most fruitful route to ensuring the safest possible development of new products. PMID:25722427

  13. Web-based documentation system with exchange of DICOM RT for multicenter clinical studies in particle therapy

    NASA Astrophysics Data System (ADS)

    Kessel, Kerstin A.; Bougatf, Nina; Bohn, Christian; Engelmann, Uwe; Oetzel, Dieter; Bendl, Rolf; Debus, Jürgen; Combs, Stephanie E.

    2012-02-01

    Conducting clinical studies is rather difficult because of the large variety of voluminous datasets, different documentation styles, and various information systems, especially in radiation oncology. In this paper, we describe our development of a web-based documentation system with first approaches of automatic statistical analyses for transnational and multicenter clinical studies in particle therapy. It is possible to have immediate access to all patient information and exchange, store, process, and visualize text data, all types of DICOM images, especially DICOM RT, and any other multimedia data. Accessing the documentation system and submitting clinical data is possible for internal and external users (e.g. referring physicians from abroad, who are seeking the new technique of particle therapy for their patients). Thereby, security and privacy protection is ensured with the encrypted https protocol, client certificates, and an application gateway. Furthermore, all data can be pseudonymized. Integrated into the existing hospital environment, patient data is imported via various interfaces over HL7-messages and DICOM. Several further features replace manual input wherever possible and ensure data quality and entirety. With a form generator, studies can be individually designed to fit specific needs. By including all treated patients (also non-study patients), we gain the possibility for overall large-scale, retrospective analyses. Having recently begun documentation of our first six clinical studies, it has become apparent that the benefits lie in the simplification of research work, better study analyses quality and ultimately, the improvement of treatment concepts by evaluating the effectiveness of particle therapy.

  14. Massage therapy: understanding the mechanisms of action on blood pressure. A scoping review.

    PubMed

    Nelson, Nicole L

    2015-10-01

    Massage therapy (MT) has shown potential in reducing blood pressure (BP); however, the psychophysiological pathways and structures involved in this outcome are unclear. The aims of this scoping review were twofold. (1) To summarize the current knowledge of the mechanisms of action of MT on BP. (2) To highlight the research gaps and challenges that researchers must overcome to further elucidate how MT attenuates BP. A scoping review was conducted to examine the evidence regarding the mechanisms of action of MT on BP. This review included the thematic analysis of 27 publications that considered the influence of MT on BP. Based on this analysis, six potential BP mediating pathways were identified Current theories suggest that MT exerts sympatholytic effects through physiologic and psychological mechanisms, improves hypothalamus-pituitary-adrenocortical axis function, and increases in blood flow, which, in turn, may improve endothelial function. Future study is needed, using more scientifically rigorous methodology, to fully elucidate the mechanism of action of MT. PMID:26324746

  15. Effects of Whole-Body Vibration Therapy in Patients with Fibromyalgia: A Systematic Literature Review

    PubMed Central

    Collado-Mateo, Daniel; Adsuar, Jose C.; Olivares, Pedro R.; del Pozo-Cruz, Borja; Parraca, Jose A.; del Pozo-Cruz, Jesus; Gusi, Narcis

    2015-01-01

    Objective. To review the literature on the effects of whole-body vibration therapy in patients with fibromyalgia. Design. Systematic literature review. Patients. Patients with fibromyalgia. Methods. An electronic search of the literature in four medical databases was performed to identify studies on whole-body vibration therapy that were published up to the 15th of January 2015. Results. Eight articles satisfied the inclusion and exclusion criteria and were analysed. According to the Dutch CBO guidelines, all selected trials had a B level of evidence. The main outcomes that were measured were balance, fatigue, disability index, health-related quality of life, and pain. Whole-body vibration appeared to improve the outcomes, especially balance and disability index. Conclusion. Whole-body vibration could be an adequate treatment for fibromyalgia as a main therapy or added to a physical exercise programme as it could improve balance, disability index, health-related quality of life, fatigue, and pain. However, this conclusion must be treated with caution because the paucity of trials and the marked differences between existing trials in terms of protocol, intervention, and measurement tools hampered the comparison of the trials. PMID:26351517

  16. Effectiveness of massage therapy for chronic, non-malignant pain: a review.

    PubMed

    Tsao, Jennie C I

    2007-06-01

    Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain. PMID:17549233

  17. Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy

    PubMed Central

    Harrison, Andrew M.; Heritier, Fabrice; Childs, Bennett G.; Bostwick, J. Michael; Dziadzko, Mikhail A.

    2015-01-01

    Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored. PMID:26576425

  18. A review of lower extremity assistive robotic exoskeletons in rehabilitation therapy.

    PubMed

    Chen, Gong; Chan, Chow Khuen; Guo, Zhao; Yu, Haoyong

    2013-01-01

    The rapid advancement of robotics technology in recent years has pushed the development of a distinctive field of robotic applications, namely robotic exoskeletons. Because of the aging population, more people are suffering from neurological disorders such as stroke, central nervous system disorder, and spinal cord injury. As manual therapy seems to be physically demanding for both the patient and therapist, robotic exoskeletons have been developed to increase the efficiency of rehabilitation therapy. Robotic exoskeletons are capable of providing more intensive patient training, better quantitative feedback, and improved functional outcomes for patients compared to manual therapy. This review emphasizes treadmill-based and over-ground exoskeletons for rehabilitation. Analyses of their mechanical designs, actuation systems, and integrated control strategies are given priority because the interactions between these components are crucial for the optimal performance of the rehabilitation robot. The review also discusses the limitations of current exoskeletons and technical challenges faced in exoskeleton development. A general perspective of the future development of more effective robot exoskeletons, specifically real-time biological synergy-based exoskeletons, could help promote brain plasticity among neurologically impaired patients and allow them to regain normal walking ability. PMID:24941413

  19. Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy.

    PubMed

    Harrison, Andrew M; Heritier, Fabrice; Childs, Bennett G; Bostwick, J Michael; Dziadzko, Mikhail A

    2015-01-01

    Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored. PMID:26576425

  20. Concise Review: Guidance in Developing Commercializable Autologous/Patient-Specific Cell Therapy Manufacturing

    PubMed Central

    Armant, Myriam; Brandwein, Harvey; Burger, Scott; Campbell, Andrew; Carpenito, Carmine; Clarke, Dominic; Fong, Timothy; Karnieli, Ohad; Niss, Knut; Van't Hof, Wouter; Wagey, Ravenska

    2013-01-01

    Cell therapy is poised to play an enormous role in regenerative medicine. However, little guidance is being made available to academic and industrial entities in the start-up phase. In this technical review, members of the International Society for Cell Therapy provide guidance in developing commercializable autologous and patient-specific manufacturing strategies from the perspective of process development. Special emphasis is placed on providing guidance to small academic or biotech researchers as to what simple questions can be addressed or answered at the bench in order to make their cell therapy products more feasible for commercial-scale production. We discuss the processes that are required for scale-out at the manufacturing level, and how many questions can be addressed at the bench level. The goal of this review is to provide guidance in the form of topics that can be addressed early in the process of development to better the chances of the product being successful for future commercialization. PMID:24101671

  1. Effects of Whole-Body Vibration Therapy in Patients with Fibromyalgia: A Systematic Literature Review.

    PubMed

    Collado-Mateo, Daniel; Adsuar, Jose C; Olivares, Pedro R; Del Pozo-Cruz, Borja; Parraca, Jose A; Del Pozo-Cruz, Jesus; Gusi, Narcis

    2015-01-01

    Objective. To review the literature on the effects of whole-body vibration therapy in patients with fibromyalgia. Design. Systematic literature review. Patients. Patients with fibromyalgia. Methods. An electronic search of the literature in four medical databases was performed to identify studies on whole-body vibration therapy that were published up to the 15th of January 2015. Results. Eight articles satisfied the inclusion and exclusion criteria and were analysed. According to the Dutch CBO guidelines, all selected trials had a B level of evidence. The main outcomes that were measured were balance, fatigue, disability index, health-related quality of life, and pain. Whole-body vibration appeared to improve the outcomes, especially balance and disability index. Conclusion. Whole-body vibration could be an adequate treatment for fibromyalgia as a main therapy or added to a physical exercise programme as it could improve balance, disability index, health-related quality of life, fatigue, and pain. However, this conclusion must be treated with caution because the paucity of trials and the marked differences between existing trials in terms of protocol, intervention, and measurement tools hampered the comparison of the trials. PMID:26351517

  2. Total skin electron beam (TSEB) therapy in pediatric patients: A review of the literature

    PubMed Central

    Skórska, Ma?gorzata.

    2013-01-01

    Aim A literature review was undertaken to identify current TSEB therapy in pediatric patients. Background Total skin electron beam (TSEB) therapy is a method of irradiation with low energy electron beam dedicated to patients who have superficial skin lesions all over their body. Such skin malignancies are sparse among adults and even more uncommon with pediatric population. Materials and methods In this study, all reported case reports were summed up with a special emphasis on techniques used, doses prescribed and special shielding of critical organs. Moreover, potential problems that were encountered during TSEB irradiation of very young patients were depicted. Results The literature has described only seven case reports of children undergoing TSEB therapy. Most of them were infants; however, two adolescents were also treated. For all infants, general anesthesia was provided to allow safe and accurate TSEB irradiation. The prescribed dose varied from 16 Gy to 28 Gy depending on the irradiation schedule and patient condition. Usually, boost fields were applied to the scalp and perineum. Typical shields for fingernails, toenails and lenses were usually used. Conclusion This paper revealed that TSEB therapy may be considered as a palliative treatment for pediatric patients with leukemia cutis. However, its role is still unclear and should be further investigated. PMID:24936329

  3. SHIELD-HIT12A - a Monte Carlo particle transport program for ion therapy research

    NASA Astrophysics Data System (ADS)

    Bassler, N.; Hansen, D. C.; Lühr, A.; Thomsen, B.; Petersen, J. B.; Sobolevsky, N.

    2014-03-01

    Purpose: The Monte Carlo (MC) code SHIELD-HIT simulates the transport of ions through matter. Since SHIELD-HIT08 we added numerous features that improves speed, usability and underlying physics and thereby the user experience. The "-A" fork of SHIELD-HIT also aims to attach SHIELD-HIT to a heavy ion dose optimization algorithm to provide MC-optimized treatment plans that include radiobiology. Methods: SHIELD-HIT12A is written in FORTRAN and carefully retains platform independence. A powerful scoring engine is implemented scoring relevant quantities such as dose and track-average LET. It supports native formats compatible with the heavy ion treatment planning system TRiP. Stopping power files follow ICRU standard and are generated using the libdEdx library, which allows the user to choose from a multitude of stopping power tables. Results: SHIELD-HIT12A runs on Linux and Windows platforms. We experienced that new users quickly learn to use SHIELD-HIT12A and setup new geometries. Contrary to previous versions of SHIELD-HIT, the 12A distribution comes along with easy-to-use example files and an English manual. A new implementation of Vavilov straggling resulted in a massive reduction of computation time. Scheduled for later release are CT import and photon-electron transport. Conclusions: SHIELD-HIT12A is an interesting alternative ion transport engine. Apart from being a flexible particle therapy research tool, it can also serve as a back end for a MC ion treatment planning system. More information about SHIELD-HIT12A and a demo version can be found on http://www.shieldhit.org.

  4. BIOLOGICAL EFFECTS OF UTAH VALLEY PARTICLES: A REVIEW

    EPA Science Inventory

    The Utah Valley provided a unique opportunity to evaluate the health effects of particulate matter (PM) in humans. The area has had intermittently high particle levels with the principal point source being a steel mill. Due to a labor dispute, the mill was shut down. The closu...

  5. TOPICAL REVIEW: State dependent particle dynamics in liquid alkali metals

    NASA Astrophysics Data System (ADS)

    Pilgrim, W.-C.; Morkel, Chr

    2006-09-01

    This paper gives a survey of the particle dynamics in the liquid alkali metals observed with inelastic x-ray and neutron scattering experiments. Liquid rubidium and sodium are chosen as model fluids to represent the behaviour of this group of fluids. In the dense metallic monatomic melt the microscopic dynamics is characterized by collective excitations similar to those in the corresponding solids. The collective particle behaviour is appropriately described using a memory function formalism with two relaxation channels for the density correlation. A similar behaviour is found for the single particle motion where again two relaxation mechanisms are needed to accurately reproduce the experimental findings. Special emphasis is given to the density dependence of the particle dynamics. An interesting issue in liquid metals is the metal to non-metal transition, which is observed if the fluid is sufficiently expanded with increasing temperature and pressure. This causes distinct variations in the interparticle interactions, which feed back onto the motional behaviour. The associated variations in structure and dynamics are reflected in the shape of the scattering laws. The experimentally observed features are discussed and compared with simple models and with the results from computer simulations.

  6. A Review of Discrete Element Method (DEM) Particle Shapes and Size Distributions for Lunar Soil

    NASA Technical Reports Server (NTRS)

    Lane, John E.; Metzger, Philip T.; Wilkinson, R. Allen

    2010-01-01

    As part of ongoing efforts to develop models of lunar soil mechanics, this report reviews two topics that are important to discrete element method (DEM) modeling the behavior of soils (such as lunar soils): (1) methods of modeling particle shapes and (2) analytical representations of particle size distribution. The choice of particle shape complexity is driven primarily by opposing tradeoffs with total number of particles, computer memory, and total simulation computer processing time. The choice is also dependent on available DEM software capabilities. For example, PFC2D/PFC3D and EDEM support clustering of spheres; MIMES incorporates superquadric particle shapes; and BLOKS3D provides polyhedra shapes. Most commercial and custom DEM software supports some type of complex particle shape beyond the standard sphere. Convex polyhedra, clusters of spheres and single parametric particle shapes such as the ellipsoid, polyellipsoid, and superquadric, are all motivated by the desire to introduce asymmetry into the particle shape, as well as edges and corners, in order to better simulate actual granular particle shapes and behavior. An empirical particle size distribution (PSD) formula is shown to fit desert sand data from Bagnold. Particle size data of JSC-1a obtained from a fine particle analyzer at the NASA Kennedy Space Center is also fitted to a similar empirical PSD function.

  7. Occupational therapy interventions to improve the reading ability of older adults with low vision: a systematic review.

    PubMed

    Smallfield, Stacy; Clem, Kari; Myers, Ashley

    2013-01-01

    This systematic review of the literature examined available evidence regarding the effectiveness of occupational therapy interventions for improving the reading performance of older adults with low vision. We reviewed 32 studies and found strong evidence supporting low vision programs that included occupational therapy and moderately strong evidence supporting the use of electronic magnification. Moderate evidence supported the influence of illumination on reading ability. Limited evidence was found to support eccentric viewing training and optical magnification. More evidence of higher quality is needed to validate the effectiveness of optical magnifiers, text eccentric viewing, characteristic preferences, and line guides within optical magnification. Additionally, further research is needed to develop a standard low vision rehabilitation program. The results of this review support the need for occupational therapy to be included in low vision rehabilitation. The implications of the findings for occupational therapy practice, research, and education are discussed. PMID:23597686

  8. Systematic Review and Meta-Analysis of Psychological Therapies for Children With Chronic Pain

    PubMed Central

    Heathcote, Lauren; Palermo, Tonya M.; de C Williams, Amanda C; Lau, Jennifer; Eccleston, Christopher

    2014-01-01

    Objectives?This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children.?Methods?Randomized controlled trials of psychological interventions treating children (<18 years) with chronic pain conditions including headache, abdominal, musculoskeletal, or neuropathic pain were searched for. Pain symptoms, disability, depression, anxiety, and sleep outcomes were extracted. Risk of bias was assessed and quality of the evidence was rated using GRADE.?Results?35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately. Sleep outcomes were not reported in any trials. Optimal dose of treatment was explored. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions.?Conclusions?Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented. PMID:24602890

  9. Systemic therapy of New World cutaneous leishmaniasis: A case report and review article

    PubMed Central

    Abadir, Amir; Patel, Ameen; Haider, Shariq

    2010-01-01

    Cutaneous leishmaniasis is a disease endemic to Central and South America, Mexico and the Caribbean, and affects millions of people. As travel to these regions becomes more common, cutaneous leishmaniasis is becoming a disease of increasing importance in the developed world. However, disease recognition and access to appropriate therapy for cutaneous leishmaniasis remains a challenge in North America. The present article reports a case of cutaneous leishmaniasis in a Canadian man following a trip to Costa Rica. Species-specific diagnosis was confirmed by polymerase chain reaction analysis of a skin biopsy, which was positive for Leishmania panamensis. After failing a course of itraconazole, the patient was successfully treated with sodium stibogluconate, despite significant barriers to administering this therapy, and the paucity of data regarding its efficacy and tolerability. The pathophysiology, diagnosis and systemic treatment of cutaneous leishmaniasis, as well as its emerging presence in the developed world, are reviewed. PMID:21629609

  10. Adverse Events of Massage Therapy in Pain-Related Conditions: A Systematic Review

    PubMed Central

    Yin, Ping; Gao, Ningyang; Wu, Junyi; Xu, Shifen

    2014-01-01

    Pain-related massage, important in traditional Eastern medicine, is increasingly used in the Western world. So the widening acceptance demands continual safety assessment. This review is an evaluation of the frequency and severity of adverse events (AEs) reported mainly for pain-related massage between 2003 and 2013. Relevant all-languages reports in 6 databases were identified and assessed by two coauthors. During the 11-year period, 40 reports of 138 AEs were associated with massage. Author, year of publication, country of occurrence, participant related (age, sex) or number of patients affected, the details of manual therapy, and clinician type were extracted. Disc herniation, soft tissue trauma, neurologic compromise, spinal cord injury, dissection of the vertebral arteries, and others were the main complications of massage. Spinal manipulation in massage has repeatedly been associated with serious AEs especially. Clearly, massage therapies are not totally devoid of risks. But the incidence of such events is low. PMID:25197310

  11. A review on the use of cell therapy in the treatment of tendon disease and injuries

    PubMed Central

    Sawadkar, Prasad; Mudera, Vivek

    2014-01-01

    Tendon disease and injuries carry significant morbidity worldwide in both athletic and non-athletic populations. It is estimated that tendon injuries account for 30%?50% of all musculoskeletal injuries globally. Current treatments have been inadequate in providing an accelerated process of repair resulting in high relapse rates. Modern concepts in tissue engineering and regenerative medicine have led to increasing interest in the application of cell therapy for the treatment of tendon disease. This review will explore the use of cell therapy, by bringing together up-to-date evidence from in vivo human and animal studies, and discuss the issues surrounding the safety and efficacy of its use in the treatment of tendon disease. PMID:25383170

  12. Iatrogenic Cushing's syndrome and topical steroid therapy: case series and review of the literature.

    PubMed

    Decani, Sem; Federighi, Veronica; Baruzzi, Elisa; Sardella, Andrea; Lodi, Giovanni

    2014-12-01

    Topical corticosteroids are considered first-line therapy in patients with chronic inflammatory oral mucosal diseases; among them, clobetasol propionate is one of the most widely used in oral medicine. Under physiological conditions, the transmucosal application is characterized by a significantly greater absorption than the skin application. Contrary to many publications about the side effects of topical corticosteroids in dermatology, few studies have investigated the systemic effects due to local application of these drugs on oral mucosa. Although topical steroid therapy for the management of oral diseases is generally associated with local adverse effects (candidiasis, stomatopyrosis, and hypogeusia), these drugs can also lead to systemic side effects, such as suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome. This review reports five cases of systemic adverse effects caused by clobetasol propionate topical treatment. PMID:23210698

  13. Intraoperative radiation therapy on pancreatic cancer patients: a review of the literature.

    PubMed

    Zygogianni, G A; Kyrgias, G; Kouvaris, J; Antypas, C; Skarlatos, J; Armpilia, C; Nikiteas, N; Kouloulias, E V

    2011-08-01

    Pancreatic cancer is rarely curable, and the overall survival rate at 5 years is under 4%. This study aimed to assess the efficacy, effectiveness and safety of intraoperative radiation therapy (IORT) as treatment in pancreatic cancer, by means of a systematic review of the literature. We searched Pubmed from 1980 until 2010 by means of prospective randomized trials. The aim was to assess the potential impact of IORT on local control, quality of life and overall survival. The search was restricted to articles published in English. IORT offers the opportunity to administer high doses of irradiation to areas of neoplastic involvement while attempting simultaneously to spare normal tissues in the region from potentially damaging radiation exposure. However, the results were not in favour of IORT in the case of pancreatic cancer in locally advanced and metastatic stages. There is no clear evidence to indicate the IORT as more effective than other therapies in treating pancreatic cancer. PMID:21873971

  14. Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review

    PubMed Central

    Romano, Michele; Negrini, Stefano

    2008-01-01

    Background The treatment of adolescent idiopathic scoliosis is contingent upon many variables. Simple observation is enough for less serious curvatures, but for very serious cases surgical intervention could be proposed. Between these there is a wide range of different treatments. Manual therapy is commonly used: the aim of this paper is to verify the data existing in the literature on the efficacy of this approach. Methods A systematic review of the scientific literature published internationally has been performed. We have included in the term manual therapy all the manipulative and generally passive techniques performed by an external operator. In a more specific meaning, osteopathic, chiropractic and massage techniques have been considered as manipulative therapeutic methods. We performed our systematic research in Medline, Embase, Cinhal, Cochrane Library, Pedro with the following terms: idiopathic scoliosis combined with chiropractic; manipulation; mobilization; manual therapy; massage; osteopathy; and therapeutic manipulation. The criteria for inclusion were as follows: Any kind of research; diagnosis of adolescent idiopathic scoliosis; patients treated exclusively by one of the procedures established as a standard for this review (chiropractic manipulation, osteopathic techniques, massage); and outcome in Cobb degrees. Results We founded 145 texts, but only three papers were relevant to our study. However, no one of the three satisfied all the required inclusion criteria because they were characterized by a combination of manual techniques and other therapeutic approaches. Conclusion The lack of any kind of serious scientific data does not allow us to draw any conclusion on the efficacy of manual therapy as an efficacious technique for the treatment of Adolescent idiopathic scoliosis. PMID:18211702

  15. Reduction-sensitive polymeric nanocarriers in cancer therapy: a comprehensive review

    NASA Astrophysics Data System (ADS)

    Deng, Bing; Ma, Ping; Xie, Yan

    2015-07-01

    Redox potential is regarded as a significant signal to distinguish between the extra-cellular and intra-cellular environments, as well as between tumor and normal tissues. Taking advantage of this physiological differentiation, various reduction-sensitive polymeric nanocarriers (RSPNs) have been designed and explored to demonstrate excellent stability during blood circulation but rapidly degrade and effectively trigger drug release in tumor cells. Therefore, this smart RSPN delivery system has attracted much attention in recent years, as it represents one of the most promising drug delivery strategies in cancer therapy. In this review, we will provide a comprehensive overview of RSPNs with various reducible linkages and functional groups up to date, including their design and synthetic strategies, preparation methods, drug release behavior, and their in vitro and in vivo efficacy in cancer therapy. In addition, dual- and triple-sensitive nanocarriers based on reducible disulfide bond-containing linkages will also be discussed.Redox potential is regarded as a significant signal to distinguish between the extra-cellular and intra-cellular environments, as well as between tumor and normal tissues. Taking advantage of this physiological differentiation, various reduction-sensitive polymeric nanocarriers (RSPNs) have been designed and explored to demonstrate excellent stability during blood circulation but rapidly degrade and effectively trigger drug release in tumor cells. Therefore, this smart RSPN delivery system has attracted much attention in recent years, as it represents one of the most promising drug delivery strategies in cancer therapy. In this review, we will provide a comprehensive overview of RSPNs with various reducible linkages and functional groups up to date, including their design and synthetic strategies, preparation methods, drug release behavior, and their in vitro and in vivo efficacy in cancer therapy. In addition, dual- and triple-sensitive nanocarriers based on reducible disulfide bond-containing linkages will also be discussed. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr02878g

  16. Characterization of Iron-Oxide Loaded Adult Stem Cells for Magnetic Particle Imaging in Targeted Cancer Therapy

    NASA Astrophysics Data System (ADS)

    Lüdtke-Buzug, Kerstin; Rapoport, Daniel Hans; Schneider, Dagmar

    2010-12-01

    Recently, magnetic particle imaging (MPI) has been presented as a new method for the measurement of the spatial distribution of superparamagnetic iron oxide nanoparticles (SPIONs). MPI is based on the nonlinear magnetization response of nanoparticles that are subjected to a sinusoidal magnetic field. Spatial resolution and signal to noise ratio of MPI depend on the particle quality. This is particularly important when stem cells shall be tracked with MPI. Stem cell-based treatment is an upcoming technology in targeted cancer-therapy. In this study, we analyzed the particle quality of newly developed dextran-coated SPIONs—with respect to their response in the imaging experiment—using magnetic particle spectrometry. The uptake of dextran-coated SPIONs into rat and human adult stem cells was monitored via transmission electron microscopy. Furthermore, adult stem cells were incubated with FITC-dextran-coated SPIONs and stained for confocal laser scanning microscopy. The dextran- and FITC-dextran coated SPIONs were localized in the cytoplasm of rat and human adult stem cells. MPI promises real-time imaging with high spatial resolution at high sensitivity. Our data support iron oxide loaded adult stem cells as a powerful tool for targeted cancer therapy.

  17. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews.

    PubMed

    Wu, Xinyin; Chung, Vincent Ch; Hui, Edwin P; Ziea, Eric Tc; Ng, Bacon Fl; Ho, Robin St; Tsoi, Kelvin Kf; Wong, Samuel Ys; Wu, Justin Cy

    2015-01-01

    Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are often used to manage cancer-related symptoms, but their effectiveness and safety are controversial. We conducted this overview to summarise the evidence on acupuncture for palliative care of cancer. Our systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews in this overview, assessed using the Methodological Quality of Systematic Reviews Instrument, was found to be satisfactory. There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients' quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. Because acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer, especially for clinical problems for which conventional care options are limited. PMID:26608664

  18. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews

    PubMed Central

    Wu, Xinyin; Chung, Vincent CH; Hui, Edwin P; Ziea, Eric TC; Ng, Bacon FL; Ho, Robin ST; Tsoi, Kelvin KF; Wong, Samuel YS; Wu, Justin CY

    2015-01-01

    Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are often used to manage cancer-related symptoms, but their effectiveness and safety are controversial. We conducted this overview to summarise the evidence on acupuncture for palliative care of cancer. Our systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews in this overview, assessed using the Methodological Quality of Systematic Reviews Instrument, was found to be satisfactory. There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients’ quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. Because acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer, especially for clinical problems for which conventional care options are limited. PMID:26608664

  19. Game-Based Digital Interventions for Depression Therapy: A Systematic Review and Meta-Analysis

    PubMed Central

    Theng, Yin-Leng; Foo, Schubert

    2014-01-01

    Abstract The aim of this study was to review the existing literature on game-based digital interventions for depression systematically and examine their effectiveness through a meta-analysis of randomized controlled trials (RCTs). Database searching was conducted using specific search terms and inclusion criteria. A standard meta-analysis was also conducted of available RCT studies with a random effects model. The standard mean difference (Cohen's d) was used to calculate the effect size of each study. Nineteen studies were included in the review, and 10 RCTs (eight studies) were included in the meta-analysis. Four types of game interventions—psycho-education and training, virtual reality exposure therapy, exercising, and entertainment—were identified, with various types of support delivered and populations targeted. The meta-analysis revealed a moderate effect size of the game interventions for depression therapy at posttreatment (d=?0.47 [95% CI ?0.69 to ?0.24]). A subgroup analysis showed that interventions based on psycho-education and training had a smaller effect than those based on the other forms, and that self-help interventions yielded better outcomes than supported interventions. A higher effect was achieved when a waiting list was used as the control. The review and meta-analysis support the effectiveness of game-based digital interventions for depression. More large-scale, high-quality RCT studies with sufficient long-term data for treatment evaluation are needed. PMID:24810933

  20. Prospects For and Progress Towards Laser-Driven Particle Therapy Accelerators

    SciTech Connect

    Cowan, T. E.; Schramm, U.; Burris-Mog, T.; Fiedler, F.; Kraft, S. D.; Zeil, K.; Bussmann, M.; Gaillard, S.; Herrmannsdoerfer, T.; Kluge, T.; Schmidt, B.; Sobiella, M.; Sauerbrey, R.; Baumann, M.; Enghardt, W.; Pawelke, J.; Flippo, K.; Harres, K.; Nuernberg, F.; Roth, M.

    2010-11-04

    Recent advances in laser-ion acceleration have motivated research towards laser-driven compact accelerators for medical therapy. Realizing laser-ion acceleration for medical therapy will require adapting the medical requirements to the foreseeable laser constraints, as well as advances in laser-acceleration physics, beam manipulation and delivery, real-time dosimetry, treatment planning and translational research into a clinical setting.

  1. Does yoga therapy reduce blood pressure in patients with hypertension?: an integrative review.

    PubMed

    Okonta, Nkechi Rose

    2012-01-01

    The aim of this article was to present a evidence-based integrative research review that validates yoga therapy as an effective complementary treatment in the management of high blood pressure (BP). The article also uses the theoretical framework of Dr Hans Selye's general adaptation syndrome. Yoga researchers demonstrate that yoga works because it modulates the physiological system of the body, specifically its effect on the heart rate. This review is significant because yoga presents an effective method of treating hypertension that is nonpharmacologic and therefore there are no adverse effects and there are other valuable health benefits. Research suggests that stress is a contributing factor to high BP; hence, the use of the general adaptation syndrome and the most important attribute of yoga, that is, it is a physical and mental exercise program, that is in sync with the philosophy of holistic nursing care where one treats the whole individual and not just the disease. The review was conducted with a search of computerized databases such as OVID, Academic Search Premier, CINAHL, MEDLINE, and Health Source: Nursing/Academic edition, PsychINFO, as well as reliable Web sites such as the cdc.gov, among others. An integrative review search was conducted, and 10 studies met the inclusion criteria. They include a combination of randomized controlled trials, quasi-experimental studies, and pilot studies. Yoga therapy is a multifunctional exercise modality with numerous benefits. Not only does yoga reduce high BP but it has also been demonstrated to effectively reduce blood glucose level, cholesterol level, and body weight, major problems affecting the American society. The completed integrative review provides guidelines for nursing implementation as a complementary treatment of high BP. PMID:22517349

  2. Adjuvant Chemoradiation Therapy in Gastric Cancer: Critically Reviewing the Past and Visualizing the Next Step Forward

    PubMed Central

    Papadimitriou, Konstantinos; Antoniou, Georgios; Bronte, Giuseppe; Vassiliou, Vassilios; Papamichael, Demetris; Peeters, Marc; Kountourakis, Panteleimon

    2015-01-01

    Gastric cancer remains one of the most common malignancies worldwide. Despite the significant advances in surgical treatment and multimodality strategies, prognosis has modestly improved over the last two decades. Locoregional relapse remains one of the main issues and the combined chemoradiation treatment seems to be one of the preferred approaches. However, more than ten years after the hallmark INT-0116 trial, minimal progress has been made both in terms of effectiveness and toxicity. Moreover, new regimens added to combined therapy failed to prove favourable results. Herein, we attempt a thorough literature review comparing pros and cons of all relative studies and potential bias, targeting well-designed future approaches. PMID:26101524

  3. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

    PubMed Central

    Camacho, Macario; Certal, Victor; Abdullatif, Jose; Zaghi, Soroush; Ruoff, Chad M.; Capasso, Robson; Kushida, Clete A.

    2015-01-01

    Objective: To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data. Data Sources: Web of Science, Scopus, MEDLINE, and The Cochrane Library. Review Methods: The searches were performed through June 18, 2014. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Results: Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The pre- and post-MT apneahypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 24.5 ± 14.3/h to 12.3 ± 11.8/h, mean difference (MD) ?14.26 [95% confidence interval (CI) ?20.98, ?7.54], P < 0.0001. Lowest oxygen saturations improved from 83.9 ± 6.0% to 86.6 ± 7.3%, MD 4.19 (95% CI 1.85, 6.54), P = 0.0005. Polysomnography snoring decreased from 14.05 ± 4.89% to 3.87 ± 4.12% of total sleep time, P < 0.001, and snoring decreased in all three studies reporting subjective outcomes. Epworth Sleepiness Scale decreased from 14.8 ± 3.5 to 8.2 ± 4.1. Two pediatric studies (25 patients) reported outcomes. In the first study of 14 children, the AHI decreased from 4.87 ± 3.0/h to 1.84 ± 3.2/h, P = 0.004. The second study evaluated children who were cured of OSA after adenotonsillectomy and palatal expansion, and found that 11 patients who continued MT remained cured (AHI 0.5 ± 0.4/h), whereas 13 controls had recurrent OSA (AHI 5.3 ± 1.5/h) after 4 y. Conclusion: Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments. Citation: Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. SLEEP 2015;38(5):669–675. PMID:25348130

  4. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

    PubMed Central

    Hofmann, Stefan G.; Asnaani, Anu; Vonk, Imke J.J.; Sawyer, Alice T.; Fang, Angela

    2012-01-01

    Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples. PMID:23459093

  5. Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C: A review and analysis of 36 cases

    PubMed Central

    Afshar, M.; Martinez, A.D.; Gallo, R.L.; Hata, T.R.

    2012-01-01

    Background Interferon-alpha (IFN-?) therapy is used to treat hepatitis C infection. The exacerbation and occurrence of psoriasis in hepatitis C patients treated with IFN-? is increasingly recognized, but the distinct associated features, etiology, and management have not been reviewed. Objective To review all published cases of hepatitis C patients who developed psoriasis while receiving IFN-? therapy. Methods The review was conducted by searching the PubMed database using the keywords “hepatitis C” AND “psoriasis.” In addition, references to additional publications not indexed for PubMed were followed to obtain a complete record of published data. Results We identified 32 publications describing 36 subjects who developed a psoriatic eruption while receiving IFN-? therapy for hepatitis C. Topical therapies were a commonly employed treatment modality but led to resolution in only 30% of cases in which they were employed solely. Cessation of IFN-? therapy led to resolution in 93% of cases. 100% of those who developed psoriasis while on IFN-? therapy responded to systemic therapy and were able to continue the drug. Conclusion Further studies and analysis of IFN-?-induced lesions are necessary to clarify the role of IFN-? and the hepatitis C virus in the development of psoriatic lesions. PMID:22671985

  6. Tissue decomposition from dual energy CT data for MC based dose calculation in particle therapy

    PubMed Central

    Hünemohr, Nora; Paganetti, Harald; Greilich, Steffen; Jäkel, Oliver; Seco, Joao

    2014-01-01

    Purpose: The authors describe a novel method of predicting mass density and elemental mass fractions of tissues from dual energy CT (DECT) data for Monte Carlo (MC) based dose planning. Methods: The relative electron density ?e and effective atomic number Zeff are calculated for 71 tabulated tissue compositions. For MC simulations, the mass density is derived via one linear fit in the ?e that covers the entire range of tissue compositions (except lung tissue). Elemental mass fractions are predicted from the ?e and the Zeff in combination. Since particle therapy dose planning and verification is especially sensitive to accurate material assignment, differences to the ground truth are further analyzed for mass density, I-value predictions, and stopping power ratios (SPR) for ions. Dose studies with monoenergetic proton and carbon ions in 12 tissues which showed the largest differences of single energy CT (SECT) to DECT are presented with respect to range uncertainties. The standard approach (SECT) and the new DECT approach are compared to reference Bragg peak positions. Results: Mean deviations to ground truth in mass density predictions could be reduced for soft tissue from (0.5±0.6)% (SECT) to (0.2±0.2)% with the DECT method. Maximum SPR deviations could be reduced significantly for soft tissue from 3.1% (SECT) to 0.7% (DECT) and for bone tissue from 0.8% to 0.1%. Mean I-value deviations could be reduced for soft tissue from (1.1±1.4%, SECT) to (0.4±0.3%) with the presented method. Predictions of elemental composition were improved for every element. Mean and maximum deviations from ground truth of all elemental mass fractions could be reduced by at least a half with DECT compared to SECT (except soft tissue hydrogen and nitrogen where the reduction was slightly smaller). The carbon and oxygen mass fraction predictions profit especially from the DECT information. Dose studies showed that most of the 12 selected tissues would profit significantly (up to 2.2%) from DECT material decomposition with no noise present. The ?e associated with an absolute noise of ±0.01 and Zeff associated with an absolute noise of ±0.2 resulted in ±10% standard variation in the carbon and oxygen mass fraction prediction. Conclusions: Accurate stopping power prediction is mainly determined by the correct mass density prediction. Theoretical improvements in range predictions with DECT data in the order of 0.1%–2.1% were observed. Further work is needed to quantify the potential improvements from DECT compared to SECT in measured image data associated with artifacts and noise. PMID:24877809

  7. Advanced pancreatic adenocarcinoma: a review of current treatment strategies and developing therapies

    PubMed Central

    Teague, Andrea; Lim, Kian-Huat

    2015-01-01

    Pancreatic adenocarcinoma is one of the deadliest solid malignancies. A large proportion of patients are diagnosed with locally advanced or metastatic disease at the time of presentation and, unfortunately, this severely limits the number of patients who can undergo surgical resection, which offers the only chance for cure. Recent therapeutic advances for patients with advanced pancreatic cancer have extended overall survival, but prognosis still remains grim. Given that traditional chemotherapy is ineffective in curing advanced pancreatic adenocarcinoma, current research is taking a multidirectional approach in the hopes of developing more effective treatments. This article reviews the major clinical trial data that is the basis for the current chemotherapy regimens used as first- and second-line treatments for advanced pancreatic adenocarcinoma. We also review the current ongoing clinical trials, which include the use of agents targeting the oncogenic network signaling of K-Ras, agents targeting the extracellular matrix, and immune therapies. PMID:25755680

  8. A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome

    PubMed Central

    Lauche, Romy; Cramer, Holger; Häuser, Winfried; Dobos, Gustav; Langhorst, Jost

    2015-01-01

    Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety. PMID:26246841

  9. A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome.

    PubMed

    Lauche, Romy; Cramer, Holger; Häuser, Winfried; Dobos, Gustav; Langhorst, Jost

    2015-01-01

    Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety. PMID:26246841

  10. First exit times of harmonically trapped particles: a didactic review

    NASA Astrophysics Data System (ADS)

    Grebenkov, Denis S.

    2015-01-01

    We revise the classical problem of characterizing first exit times of a harmonically trapped particle whose motion is described by a one- or multidimensional Ornstein-Uhlenbeck process. We start by recalling the main derivation steps of a propagator using Langevin and Fokker-Planck equations. The mean exit time, the moment-generating function and the survival probability are then expressed through confluent hypergeometric functions and thoroughly analyzed. We also present a rapidly converging series representation of confluent hypergeometric functions that is particularly well suited for numerical computation of eigenvalues and eigenfunctions of the governing Fokker-Planck operator. We discuss several applications of first exit times, such as the detection of time intervals during which motor proteins exert a constant force onto a tracer in optical tweezers single-particle tracking experiments; adhesion bond dissociation under mechanical stress; characterization of active periods of trend-following and mean-reverting strategies in algorithmic trading on stock markets; relation to the distribution of first crossing times of a moving boundary by Brownian motion. Some extensions are described, including diffusion under quadratic double-well potential and anomalous diffusion.

  11. Bench-to-bedside review: Immunoglobulin therapy for sepsis - biological plausibility from a critical care perspective

    PubMed Central

    2012-01-01

    Sepsis represents a dysregulated host response to infection, the extent of which determines the severity of organ dysfunction and subsequent outcome. All trialled immunomodulatory strategies to date have resulted in either outright failure or inconsistent degrees of success. Intravenous immunoglobulin (IVIg) therapy falls into the latter category with opinion still divided as to its utility. This article provides a narrative review of the biological rationale for using IVIg in sepsis. A literature search was conducted using the PubMed database (1966 to February 2011). The strategy included the following text terms and combinations of these: IVIg, intravenous immune globulin, intravenous immunoglobulin, immunoglobulin, immunoglobulin therapy, pentaglobin, sepsis, inflammation, immune modulation, apoptosis. Preclinical and extrapolated clinical data of IVIg therapy in sepsis suggests improved bacterial clearance, inhibitory effects upon upstream mediators of the host response (for example, the nuclear factor kappa B (NF-?B) transcription factor), scavenging of downstream inflammatory mediators (for example, cytokines), direct anti-inflammatory effects mediated via Fc? receptors, and a potential ability to attenuate lymphocyte apoptosis and thus sepsis-related immunosuppression. Characterizing the trajectory of change in immunoglobulin levels during sepsis, understanding mechanisms contributing to these changes, and undertaking IVIg dose-finding studies should be performed prior to further large-scale interventional trials to enhance the likelihood of a successful outcome. PMID:22424150

  12. A systematic review of the use of technology for reminiscence therapy.

    PubMed

    Lazar, Amanda; Thompson, Hilaire; Demiris, George

    2014-10-01

    As the segment of the population 65 years of age or older continues to grow, the number of individuals with dementia increases proportionally, highlighting the need to design therapies that meet the social and emotional needs of people with dementia. Information and communication technologies (ICT) are potential venues for supporting the delivery of such therapies, including reminiscence therapy (RT), which is a non-pharmacological intervention involving the prompting of past memories, often with artifacts such as old photographs or music for therapeutic benefits such as the facilitation of social interactions or the increase of self-esteem. This paper systematically examines the scientific literature on the use of ICT for facilitating RT to assess the current state of the evidence and identify future trends. We searched the PubMed (1966-2013), ACM (1954-2013), and PsycINFO (1908-2013) repositories using the keywords dementia and reminiscence. Three hundred eighty-six articles were retrieved, 44 of which met the inclusion and exclusion criteria. Findings of the systematic review include that there are benefits to using ICT for RT interventions. Some of these benefits are access to rich and engaging multimedia reminiscence materials, opportunities for people with dementia to participate in social interactions and take ownership of conversations, and a reduction of barriers due to motor deficits during interactions with media. Future studies should explore the types and content of media beneficial to individuals at different stages of dementia. PMID:25274711

  13. Macrolide therapy in cryptogenic organizing pneumonia: A case report and literature review

    PubMed Central

    DING, QUN-LI; LV, DAN; WANG, BI-JIONG; ZHANG, QIAO-LI; YU, YI-MING; SUN, SHI-FANG; CHEN, ZHONG-BO; MA, HONG-YING; DENG, ZAI-CHUN

    2015-01-01

    Cryptogenic organizing pneumonia (COP) is a pulmonary disorder associated with nonspecific clinical presentations. The macrolide class of antimicrobial agents is widely used to treat infectious and inflammatory respiratory diseases in humans. The present study reports a case of COP that was effectively treated with azithromycin in combination with glucocorticoid. A literature review of similar cases is also presented. It was found that all COP patients in the literature received macrolide treatment, including six cases with unknown clinical outcomes. For the remaining 29 patients, 20 patients initially received the macrolide as a single therapy and 4/5 of them (16 cases) were cured with a treatment time of 3–14 months, while 1/5 (4 cases) showed no improvement after treatment for 1 month and were switched to a glucocorticoid or combination treatment with a glucocorticoid, after which the disease was finally well-controlled. Side-effects of macrolide were rare. Based on this analysis, it is recommended that macrolides can be used as a first-line therapy in patients with mild COP. For patients with recurrent COP, it is suggested that macrolides should be used as an adjunctive therapy with other treatments, such as a glucocorticoid. PMID:25667636

  14. Psychodynamic therapies with infants and parents: a critical review of treatment methods.

    PubMed

    Salomonsson, Björn

    2014-06-01

    The theory of psychoanalysis has always relied on speculations about the infant's mind, but its clinical practice was slow in taking an interest in babies and their parents. The therapy methods that nevertheless have evolved during the last 50 years differ in their emphasis on support or insight, which roles they attribute to mother and baby in therapy, and to what extent they focus on the unconscious influences in mother and baby, respectively. They also differ to what extent their theories rely on classical psychoanalysis, attachment psychology, developmental psychology, and infant research. Each method also contains assumptions, most often tacit, about which kinds of samples for which they are most suited. The article describes the most well-known modes of psychodynamic therapy with infants and parents (PTIP). There is a certain emphasis on methods that are less known to the U.S. readership, such as the French and Scandinavian traditions. It submits them and the other methods to a critical review. PMID:24828591

  15. Magnetic Seizure Therapy for Unipolar and Bipolar Depression: A Systematic Review

    PubMed Central

    Cretaz, Eric; Brunoni, André R.

    2015-01-01

    Objective. Magnetic seizure therapy (MST) is a novel, experimental therapeutic intervention, which combines therapeutic aspects of electroconvulsive therapy (ECT) and transcranial magnetic stimulation, in order to achieve the efficacy of the former with the safety of the latter. MST might prove to be a valuable tool in the treatment of mood disorders, such as major depressive disorder (MDD) and bipolar disorder. Our aim is to review current literature on MST. Methods. OVID and MEDLINE databases were used to systematically search for clinical studies on MST. The terms “magnetic seizure therapy,” “depression,” and “bipolar” were employed. Results. Out of 74 studies, 8 met eligibility criteria. There was considerable variability in the methods employed and samples sizes were small, limiting the generalization of the results. All studies focused on depressive episodes, but few included patients with bipolar disorder. The studies found reported significant antidepressant effects, with remission rates ranging from 30% to 40%. No significant cognitive side effects related to MST were found, with a better cognitive profile when compared to ECT. Conclusion. MST was effective in reducing depressive symptoms in mood disorders, with generally less side effects than ECT. No study focused on comparing MST to ECT on bipolar depression specifically. PMID:26075100

  16. Redefining Relative Biological Effectiveness in the Context of the EQDX Formalism: Implications for Alpha-Particle Emitter Therapy

    PubMed Central

    Hobbs, Robert F.; Howell, Roger W.; Song, Hong; Baechler, Sébastien; Sgouros, George

    2014-01-01

    Alpha-particle radiopharmaceutical therapy (?RPT) is currently enjoying increasing attention as a viable alternative to chemotherapy for targeting of disseminated micrometastatic disease. In theory, ?RPT can be personalized through pre-therapeutic imaging and dosimetry. However, in practice, given the particularities of ?-particle emissions, a dosimetric methodology that accurately predicts the thresholds for organ toxicity has not been reported. This is in part due to the fact that the biological effects caused by ?-particle radiation differ markedly from the effects caused by traditional external beam (photon or electron) radiation or ?-particle emitting radiopharmaceuticals. The concept of relative biological effectiveness (RBE) is used to quantify the ratio of absorbed doses required to achieve a given biological response with alpha particles versus a reference radiation (typically a beta emitter or external beam radiation). However, as conventionally defined, the RBE varies as a function of absorbed dose and therefore a single RBE value is limited in its utility because it cannot be used to predict response over a wide range of absorbed doses. Therefore, efforts are underway to standardize bioeffect modeling for different fractionation schemes and dose rates for both nuclear medicine and external beam radiotherapy. Given the preponderant use of external beams of radiation compared to nuclear medicine in cancer therapy, the more clinically relevant quantity, the 2 Gy equieffective dose, EQD2(?/?), has recently been proposed by the ICRU. In concert with EQD2(?/?), we introduce a new, redefined RBE quantity, named RBE2(?/?), as the ratio of the two linear coefficients that characterize the ? particle absorbed dose-response curve and the low-LET megavoltage photon 2 Gy fraction equieffective dose-response curve. The theoretical framework for the proposed new formalism is presented along with its application to experimental data obtained from irradiation of a breast cancer cell line. Radiobiological parameters are obtained using the linear quadratic model to fit cell survival data for MDA-MB-231 human breast cancer cells that were irradiated with either ? particles or a single fraction of low-LET 137Cs ? rays. From these, the linear coefficient for both the biologically effective dose (BED) and the EQD2(?/?) response lines were derived for fractionated irradiation. The standard RBE calculation, using the traditional single fraction reference radiation, gave RBE values that ranged from 2.4 for a surviving fraction of 0.82–6.0 for a surviving fraction of 0.02, while the dose-independent RBE2(4.6) value was 4.5 for all surviving fraction values. Furthermore, bioeffect modeling with RBE2(?/?) and EQD2(?/?) demonstrated the capacity to predict the surviving fraction of cells irradiated with acute and fractionated low-LET radiation, ? particles and chronic exponentially decreasing dose rates of low-LET radiation. RBE2(?/?) is independent of absorbed dose for ?-particle emitters and it provides a more logical framework for data reporting and conversion to equieffective dose than the conventional dose-dependent definition of RBE. Moreover, it provides a much needed foundation for the ongoing development of an ?-particle dosimetry paradigm and will facilitate the use of tolerance dose data available from external beam radiation therapy, thereby helping to develop ?RPT as a single modality as well as for combination therapies. PMID:24502376

  17. AEROSOL THERAPY IMPLICATIONS OF PARTICLE DEPOSITION PATTERNS IN SIMULATED HUMAN AIRWAYS

    EPA Science Inventory

    The efficacy of inhalation therapy may be improved by the selective deposition of aerosolized medicines, by explicitly targeting and delivering drugs to prescribed lung sites. ere, the deposition patterns of test aerosols, mapped in surrogate respiratory tracts consisting of repl...

  18. Quantitative single-particle digital autoradiography with ?-particle emitters for targeted radionuclide therapy using the iQID camera

    SciTech Connect

    Miller, Brian W.; Frost, Sofia H. L.; Frayo, Shani L.; Kenoyer, Aimee L.; Santos, Erlinda; Jones, Jon C.; Orozco, Johnnie J.; Green, Damian J.; Press, Oliver W.; Pagel, John M.; Sandmaier, Brenda M.; Hamlin, Donald K.; Wilbur, D. Scott; Fisher, Darrell R.

    2015-07-15

    Purpose: Alpha-emitting radionuclides exhibit a potential advantage for cancer treatments because they release large amounts of ionizing energy over a few cell diameters (50–80 ?m), causing localized, irreparable double-strand DNA breaks that lead to cell death. Radioimmunotherapy (RIT) approaches using monoclonal antibodies labeled with ? emitters may thus inactivate targeted cells with minimal radiation damage to surrounding tissues. Tools are needed to visualize and quantify the radioactivity distribution and absorbed doses to targeted and nontargeted cells for accurate dosimetry of all treatment regimens utilizing ? particles, including RIT and others (e.g., Ra-223), especially for organs and tumors with heterogeneous radionuclide distributions. The aim of this study was to evaluate and characterize a novel single-particle digital autoradiography imager, the ionizing-radiation quantum imaging detector (iQID) camera, for use in ?-RIT experiments. Methods: The iQID camera is a scintillator-based radiation detection system that images and identifies charged-particle and gamma-ray/x-ray emissions spatially and temporally on an event-by-event basis. It employs CCD-CMOS cameras and high-performance computing hardware for real-time imaging and activity quantification of tissue sections, approaching cellular resolutions. In this work, the authors evaluated its characteristics for ?-particle imaging, including measurements of intrinsic detector spatial resolutions and background count rates at various detector configurations and quantification of activity distributions. The technique was assessed for quantitative imaging of astatine-211 ({sup 211}At) activity distributions in cryosections of murine and canine tissue samples. Results: The highest spatial resolution was measured at ?20 ?m full width at half maximum and the ?-particle background was measured at a rate as low as (2.6 ± 0.5) × 10{sup ?4} cpm/cm{sup 2} (40 mm diameter detector area). Simultaneous imaging of multiple tissue sections was performed using a large-area iQID configuration (ø 11.5 cm). Estimation of the {sup 211}At activity distribution was demonstrated at mBq/?g-levels. Conclusions: Single-particle digital autoradiography of ? emitters has advantages over traditional film-based autoradiographic techniques that use phosphor screens, in terms of spatial resolution, sensitivity, and activity quantification capability. The system features and characterization results presented in this study show that the iQID is a promising technology for microdosimetry, because it provides necessary information for interpreting alpha-RIT outcomes and for predicting the therapeutic efficacy of cell-targeted approaches using ? emitters.

  19. Early versus deferred androgen suppression therapy for patients with lymph node-positive prostate cancer after local therapy with curative intent: a systematic review

    PubMed Central

    2013-01-01

    Background There is currently no consensus regarding the optimal timing for androgen suppression therapy in patients with prostate cancer that have undergone local therapy with curative intent but are proven to have node-positive disease without signs of distant metastases at the time of local therapy. The objective of this systematic review was to determine the benefits and harms of early (at the time of local therapy) versus deferred (at the time of clinical disease progression) androgen suppression therapy for patients with node-positive prostate cancer after local therapy. Methods The protocol was registered prospectively (CRD42011001221; http://www.crd.york.ac.uk/PROSPERO). We searched the MEDLINE, EMBASE, and CENTRAL databases, as well as reference lists, the abstracts of three major conferences, and three trial registers, to identify randomized controlled trials (search update 04/08/2012). Two authors independently screened the identified articles, assessed trial quality, and extracted data. Results Four studies including 398 patients were identified for inclusion. Early androgen suppression therapy lead to a significant decrease in overall mortality (HR 0.62, 95% CI 0.46-0.84), cancer-specific mortality (HR 0.34, 95% CI 0.18-0.64), and clinical progression at 3 or 9 years (RR 0.29, 95% CI 0.16-0.52 at 3 years and RR 0.49, 95% CI 0.36-0.67 at 9 years). One study showed an increase of adverse effects with early androgen suppression therapy. All trials had substantial methodological limitations. Conclusions The data available suggest an improvement in survival and delayed disease progression but increased adverse events for patients with node-positive prostate cancer after local therapy treated with early androgen suppression therapy versus deferred androgen suppression therapy. However, quality of data is low. Randomized controlled trials with blinding of outcome assessment, planned to determine the timing of androgen suppression therapy in node-positive prostate cancer using modern diagnostic imaging modalities, biochemical testing, and standardized follow-up schedules should be conducted to confirm these findings. PMID:23510155

  20. Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

    PubMed Central

    Kwakkel, Gert; Kollen, Boudewijn J.; Krebs, Hermano I.

    2009-01-01

    Background and Purpose To present a systematic review of studies that investigates the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Summary of Review A database of articles published up to October 2006 was compiled using the following MEDLINE key words: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm and robot. References listed in relevant publications were also screened. Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; (4) The study was a randomised clinical trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and functional ability (ADL) using fixed and random effect models. Ten studies, involving 218 patients, were included in the synthesis. Their methodological quality ranged from 4 to 8 on a (maximum) 10 point scale. Meta-analysis showed a non-significant heterogeneous SES in terms of upper limb motor recovery. Sensitivity analysis of studies involving only shoulder-elbow robotics subsequently demonstrated a significant homogeneous SES for motor recovery of the upper paretic limb. No significant SES was observed for functional ability (ADL). Conclusion As a result of marked heterogeneity in studies between distal and proximal arm robotics, no overall significant effect in favour of robot-assisted therapy was found in the present meta-analysis. However, subsequent sensitivity analysis showed a significant improvement in upper limb motor function after stroke for upper arm robotics. No significant improvement was found in ADL function. However, the administered ADL scales in the reviewed studies fail to adequately reflect recovery of the paretic upper limb and valid instruments that measure outcome of dexterity of the paretic arm and hand are mostly absent in selected studies. Future research on the effects of robot-assisted therapy should therefore distinguish between upper and lower robotics arm training and concentrate on kinematical analysis to differentiate between genuine upper limb motor recovery and functional recovery due to compensation strategies by proximal control of the trunk and upper limb. PMID:17876068

  1. Adjunctive Application of Antimicrobial Photodynamic Therapy in Nonsurgical Periodontal Treatment: A Review of Literature.

    PubMed

    Kikuchi, Takeshi; Mogi, Makio; Okabe, Iichiro; Okada, Kosuke; Goto, Hisashi; Sasaki, Yasuyuki; Fujimura, Takeki; Fukuda, Mitsuo; Mitani, Akio

    2015-01-01

    Periodontal disease is caused by dental plaque biofilms, and the removal of these biofilms from the root surface of teeth plays a central part in its treatment. The conventional treatment for periodontal disease fails to remove periodontal infection in a subset of cases, such as those with complicated root morphology. Adjunctive antimicrobial photodynamic therapy (aPDT) has been proposed as an additional treatment for this infectious disease. Many periodontal pathogenic bacteria are susceptible to low-power lasers in the presence of dyes, such as methylene blue, toluidine blue O, malachite green, and indocyanine green. aPDT uses these light-activated photosensitizer that is incorporated selectively by bacteria and absorbs a low-power laser/light with an appropriate wavelength to induce singlet oxygen and free radicals, which are toxic to bacteria. While this technique has been evaluated by many clinical studies, some systematic reviews and meta-analyses have reported controversial results about the benefits of aPDT for periodontal treatment. In the light of these previous reports, the aim of this review is to provide comprehensive information about aPDT and help extend knowledge of advanced laser therapy. PMID:26473843

  2. Emerging roles of microRNAs in pancreatic cancer diagnosis, therapy and prognosis (Review)

    PubMed Central

    SUBRAMANI, RAMADEVI; GANGWANI, LAXMAN; NANDY, SUSHMITA BOSE; ARUMUGAM, ARUNKUMAR; CHATTOPADHYAY, MUNMUN; LAKSHMANASWAMY, RAJKUMAR

    2015-01-01

    Pancreatic cancer is one of the leading causes of cancer related death. Increasing incidence and mortality indicates a lack of detection and post diagnostic management of this disease. Recent evidences suggest that, miRNAs are very attractive target molecules that can serve as biomarkers for predicting development and progression of pancreatic cancer. Furthermore, miRNAs are also promising therapeutic targets for pancreatic cancer. The objective of the present review is to discuss the significance of miRNA in pancreatic cancer development, diagnosis, therapy and prognosis. We extracted and compiled the useful information from PubMed database, which satisfied our criteria for analysis of miRNAs in pancreatic cancer diagnosis, therapy and prognosis. A summary of the most important miRNAs known to regulate pancreatic tumorigenesis is provided. The review also provides a collection of evidence that show miRNA profiles of biofluids hold much promise for use as biomarkers to predict and detect development of pancreatic cancer in its early stages. Identification of key miRNA networks in pancreatic cancer will provide long-awaited diagnostic/therapeutic/prognostic tools for early detection, better treatment options, and extended life expectancy and quality of life in PDAC patients. PMID:26314882

  3. Clinical Case Reporting in the Peer-Reviewed Physical Therapy Literature: Time to Move Toward Functioning.

    PubMed

    Davenport, Todd E

    2015-12-01

    Physical therapists increasingly are contributing clinical case reports to the health literature, which form the basis for higher quality evidence that has been incorporated into clinical practice guidelines. Yet, few resources exist to assist physical therapists with the basic mechanics and quality standards of producing a clinical case report. This situation is further complicated by the absence of uniform standards for quality in case reporting. The importance of including a concise yet comprehensive description of patient functioning in all physical therapy case reports suggest the potential appropriateness of basing quality guidelines on the World Health Organization's International Classification of Functioning Disability and Health (ICF) model. The purpose of this paper is to assist physical therapists in creating high-quality clinical case reports for the peer-reviewed literature using the ICF model as a guiding framework. Along these lines, current recommendations related to the basic mechanics of writing a successful clinical case report are reviewed, as well and a proposal for uniform clinical case reporting requirements is introduced with the aim to improve the quality and feasibility of clinical case reporting in physical therapy that are informed by the ICF model. Copyright © 2013 John Wiley & Sons, Ltd. PMID:24375956

  4. Adjunctive Application of Antimicrobial Photodynamic Therapy in Nonsurgical Periodontal Treatment: A Review of Literature

    PubMed Central

    Kikuchi, Takeshi; Mogi, Makio; Okabe, Iichiro; Okada, Kosuke; Goto, Hisashi; Sasaki, Yasuyuki; Fujimura, Takeki; Fukuda, Mitsuo; Mitani, Akio

    2015-01-01

    Periodontal disease is caused by dental plaque biofilms, and the removal of these biofilms from the root surface of teeth plays a central part in its treatment. The conventional treatment for periodontal disease fails to remove periodontal infection in a subset of cases, such as those with complicated root morphology. Adjunctive antimicrobial photodynamic therapy (aPDT) has been proposed as an additional treatment for this infectious disease. Many periodontal pathogenic bacteria are susceptible to low-power lasers in the presence of dyes, such as methylene blue, toluidine blue O, malachite green, and indocyanine green. aPDT uses these light-activated photosensitizer that is incorporated selectively by bacteria and absorbs a low-power laser/light with an appropriate wavelength to induce singlet oxygen and free radicals, which are toxic to bacteria. While this technique has been evaluated by many clinical studies, some systematic reviews and meta-analyses have reported controversial results about the benefits of aPDT for periodontal treatment. In the light of these previous reports, the aim of this review is to provide comprehensive information about aPDT and help extend knowledge of advanced laser therapy. PMID:26473843

  5. Prenatal Therapy of Large Placental Chorioangiomas: Case Report and Review of the Literature

    PubMed Central

    Hosseinzadeh, Pardis; Shamshirsaz, Alireza A.; Javadian, Pouya; Espinoza, Jimmy; Gandhi, Manisha; Ruano, Rodrigo; Cass, Darrell L.; Olutoye, Oluyinka A.; Belfort, Michael A.

    2015-01-01

    Objective?To review techniques and outcomes of different prenatal treatments for large placental chorioangiomas. Study Design?Presentation of a case of laparoscopic-assisted laser coagulation and a systematic review of the literature for articles related to intervention for placental chorioangioma. Results?A total of 37 cases of definitive (n?=?23) and supportive therapy (n?=?14) were evaluated, including one case treated in our center. Approximately 35% of the patients had a spontaneous preterm delivery in definitive treatment group versus 36% in the supportive group. The infant survival rates were 65 and 71% in the two groups, respectively. We further compared the two types of laser ablation (fetoscopic [n?=?10] and interstitial [n?=?4]). Approximately 30% of the patients in the fetoscopic and 25% in interstitial group, had a spontaneous preterm delivery. Survival rates were 60 and 100% in fetoscopic and interstitial groups, respectively. Conclusion?Laser ablation and embolization of chorioangiomas via minimally invasive approach may prevent or reverse fetal hydrops due to high cardiac states. However, further studies are needed to refine the appropriate selection criteria that will justify the risk of this invasive in utero therapy for chorioangiomas. PMID:26495184

  6. Effect of low-level laser therapy on mesenchymal stem cell proliferation: a systematic review.

    PubMed

    Ginani, Fernanda; Soares, Diego Moura; Barreto, Mardem Portela E Vasconcelos; Barboza, Carlos Augusto Galvão

    2015-11-01

    Low-level laser therapy (LLLT) has been used in several in vitro experiments in order to stimulate cell proliferation. Cells such as fibroblasts, keratinocytes, lymphocytes, and osteoblasts have shown increased proliferation when submitted to laser irradiation, although little is known about the effects of LLLT on stem cells. This study aims to assess, through a systematic literature review, the effects of LLLT on the in vitro proliferation of mesenchymal stem cells. Using six different terms, we conducted an electronic search in PubMed/Medline database for articles published in the last twelve years. From 463 references obtained, only 19 papers met the search criteria and were included in this review. The analysis of the papers showed a concentration of experiments using LLLT on stem cells derived from bone marrow, dental pulp, periodontal ligament, and adipose tissue. Several protocols were used to irradiate the cells, with variations on wavelength, power density, radiation time, and state of light polarization. Most studies demonstrated an increase in the proliferation rate of the irradiated cells. It can be concluded that the laser therapy positively influences the in vitro proliferation of stem cells studied, being necessary to carry out further experiments on other cell types and to uniform the methodological designs. PMID:25764448

  7. Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies.

    PubMed

    Kerley, Conor P; Elnazir, Basil; Faul, John; Cormican, Liam

    2015-06-01

    Vitamin D deficiency (VDD) is highly prevalent worldwide, with adverse effects on bone health but also potentially other unfavorable consequences. VDD and asthma-incidence/severity share many common risk factors, including winter season, industrialization, poor diet, obesity, dark skin pigmentation, and high latitude. Multiple anatomical areas relevant to asthma contain both the enzyme responsible for producing activated vitamin D and the vitamin D receptor suggesting that activated vitamin D (1,25-dihydroxyvitamin D) may have important local effects at these sites. Emerging evidence suggests that VDD is associated with increased airway hyperresponsiveness, decreased pulmonary function, worse asthma control, and possibly decreased response to standard anti-asthma therapy. However the effect is inconsistent with preliminary evidence from different studies suggesting vitamin D is both beneficial and detrimental to asthma genesis and severity. Current evidence suggests that supplementation with moderate doses of vitamin D may be appropriate for maintenance of bone health in asthmatics, particularly steroid users. However emerging data from an increasing number of randomized, controlled, intervention studies of vitamin D supplementation in pediatric and adult asthma are becoming available and should help determine the importance, if any of vitamin D for asthma pathogenesis. The purpose of this second of a two-part review is to review the current human literature on vitamin D and asthma, discussing the possible consequences of VDD for asthma and the potential for vitamin D repletion as adjunct therapy. PMID:25749414

  8. Cancer Pain: A Critical Review of Mechanism-based Classification and Physical Therapy Management in Palliative Care

    PubMed Central

    Kumar, Senthil P

    2011-01-01

    Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms – central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective – operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain. PMID:21976851

  9. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis

    PubMed Central

    Kim, Sung-Hee; Gerver, Sarah M.; Fidler, Sarah; Ward, Helen

    2014-01-01

    Objective: Adolescent and young adult (AYA) populations (12–24 years) represent over 40% of new HIV infections globally. Adolescence is sometimes characterized by high-risk sexual behaviour and a lack of engagement with healthcare services that can affect adherence to antiretroviral therapy (ART). Despite adherence to ART being critical in controlling viral replication, maintaining health and reducing onward viral transmission, there are limited data on ART adherence amongst AYA globally. We undertook a systematic review and meta-analysis of published studies reporting adherence to ART for AYA living with HIV. Design and methods: Searches included Embase, Medline and PsychINFO databases up to 14 August 2013. Eligible studies defined adequate adherence as at least 85% on self-report or undetectable blood plasma virus levels. A random effects meta-analysis was performed and heterogeneity examined using meta-regression. Results: We identified 50 eligible articles reporting data from 53 countries and 10?725 patients. Using a pooled analysis of all eligible studies, 62.3% [95% confidence interval (CI) 57.1–67.6; I2?:?97.2%] of the AYA population were adherent to therapy. The lowest average ART adherence was in North America [53% (95% CI 46–59; I2?:?91%)], Europe [62% (95% CI 51–73; I2?:?97%)] and South America [63% (95% CI 47–77; I2?:?85%] and, with higher levels in Africa [84% (95% CI 79–89; I2?:?93%)] and Asia [84% (95% CI 77–91; I2?:?0%]. Conclusion: Review of published literature from Africa and Asia indicate more than 70% of HIV-positive AYA populations receiving ART are adherent to therapy and lower rates of adherence were shown in Europe and North America at 50–60%. The global discrepancy is probably multifactorial reflecting differences between focused and generalised epidemics, access to healthcare and funding. PMID:24845154

  10. Quantitative Single-Particle Digital Autoradiography with ?-Particle Emitters for Targeted Radionuclide Therapy using the iQID Camera

    SciTech Connect

    Miller, Brian W.; Frost, Sophia; Frayo, Shani; Kenoyer, Aimee L.; Santos, E. B.; Jones, Jon C.; Green, Damian J.; Hamlin, Donald K.; Wilbur, D. Scott; Fisher, Darrell R.; Orozco, Johnnie J.; Press, Oliver W.; Pagel, John M.; Sandmaier, B. M.

    2015-07-01

    Abstract Alpha emitting radionuclides exhibit a potential advantage for cancer treatments because they release large amounts of ionizing energy over a few cell diameters (50–80 ?m) causing localized, irreparable double-strand DNA breaks that lead to cell death. Radioimmunotherapy (RIT) approaches using monoclonal antibodies labeled with alpha emitters may inactivate targeted cells with minimal radiation damage to surrounding tissues. For accurate dosimetry in alpha-RIT, tools are needed to visualize and quantify the radioactivity distribution and absorbed dose to targeted and non-targeted cells, especially for organs and tumors with heterogeneous radionuclide distributions. The aim of this study was to evaluate and characterize a novel single-particle digital autoradiography imager, iQID (ionizing-radiation Quantum Imaging Detector), for use in alpha-RIT experiments. Methods: The iQID camera is a scintillator-based radiation detection technology that images and identifies charged-particle and gamma-ray/X-ray emissions spatially and temporally on an event-by-event basis. It employs recent advances in CCD/CMOS cameras and computing hardware for real-time imaging and activity quantification of tissue sections, approaching cellular resolutions. In this work, we evaluated this system’s characteristics for alpha particle imaging including measurements of spatial resolution and background count rates at various detector configurations and quantification of activity distributions. The technique was assessed for quantitative imaging of astatine-211 (211At) activity distributions in cryosections of murine and canine tissue samples. Results: The highest spatial resolution was measured at ~20 ?m full width at half maximum (FWHM) and the alpha particle background was measured at a rate of (2.6 ± 0.5) × 10–4 cpm/cm2 (40 mm diameter detector area). Simultaneous imaging of multiple tissue sections was performed using a large-area iQID configuration (ø 11.5 cm). Estimation of the 211At activity distribution was demonstrated at mBq/?g levels. Conclusion: Single-particle digital autoradiography of alpha emitters has advantages over traditional autoradiographic techniques in terms of spatial resolution, sensitivity, and activity quantification capability. The system features and characterization results presented in this study show that iQID is a promising technology for microdosimetry, because it provides necessary information for interpreting alpha-RIT outcomes and for predicting the therapeutic efficacy of cell-targeted approaches using alpha emitters.

  11. May spa therapy be a valid opportunity to treat hand osteoarthritis? A review of clinical trials and mechanisms of action.

    PubMed

    Fortunati, Nicola Angelo; Fioravanti, Antonella; Seri, Gina; Cinelli, Simone; Tenti, Sara

    2016-01-01

    Osteoarthritis (OA) is the most common form of arthritis and its current treatment includes non-pharmacological and pharmacological modalities. Spa therapy represents a popular treatment for many rheumatic diseases. The aim of this review was to summarize the currently available information on clinical effects and mechanisms of action of spa therapy in OA of the hand. We conducted a search of the literature to extract articles describing randomized clinical trials (RCTs) in hand OA published in the period 1952-2015. We identified three assessable articles reporting RCTs on spa therapy in hand OA. Data from these clinical trials support a beneficial effect of spa therapy on pain, function and quality of life in hand OA. Spa therapy seems to have a role in the treatment of hand OA. However, additional RCTs are necessary to clarify the mechanisms of action and the effects of the application of thermal treatments. PMID:26156832

  12. May spa therapy be a valid opportunity to treat hand osteoarthritis? A review of clinical trials and mechanisms of action

    NASA Astrophysics Data System (ADS)

    Fortunati, Nicola Angelo; Fioravanti, Antonella; Seri, Gina; Cinelli, Simone; Tenti, Sara

    2015-07-01

    Osteoarthritis (OA) is the most common form of arthritis and its current treatment includes non-pharmacological and pharmacological modalities. Spa therapy represents a popular treatment for many rheumatic diseases. The aim of this review was to summarize the currently available information on clinical effects and mechanisms of action of spa therapy in OA of the hand. We conducted a search of the literature to extract articles describing randomized clinical trials (RCTs) in hand OA published in the period 1952-2015. We identified three assessable articles reporting RCTs on spa therapy in hand OA. Data from these clinical trials support a beneficial effect of spa therapy on pain, function and quality of life in hand OA. Spa therapy seems to have a role in the treatment of hand OA. However, additional RCTs are necessary to clarify the mechanisms of action and the effects of the application of thermal treatments.

  13. Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations

    PubMed Central

    Herman, Patricia M; Poindexter, Beth L; Witt, Claudia M; Eisenberg, David M

    2012-01-01

    Objective A comprehensive systematic review of economic evaluations of complementary and integrative medicine (CIM) to establish the value of these therapies to health reform efforts. Data sources PubMed, CINAHL, AMED, PsychInfo, Web of Science and EMBASE were searched from inception through 2010. In addition, bibliographies of found articles and reviews were searched, and key researchers were contacted. Eligibility criteria for selecting studies Studies of CIM were identified using criteria based on those of the Cochrane complementary and alternative medicine group. All studies of CIM reporting economic outcomes were included. Study appraisal methods All recent (and likely most cost-relevant) full economic evaluations published 2001–2010 were subjected to several measures of quality. Detailed results of higher-quality studies are reported. Results A total of 338 economic evaluations of CIM were identified, of which 204, covering a wide variety of CIM for different populations, were published 2001–2010. A total of 114 of these were full economic evaluations. And 90% of these articles covered studies of single CIM therapies and only one compared usual care to usual care plus access to multiple licensed CIM practitioners. Of the recent full evaluations, 31 (27%) met five study-quality criteria, and 22 of these also met the minimum criterion for study transferability (‘generalisability’). Of the 56 comparisons made in the higher-quality studies, 16 (29%) show a health improvement with cost savings for the CIM therapy versus usual care. Study quality of the cost-utility analyses (CUAs) of CIM was generally comparable to that seen in CUAs across all medicine according to several measures, and the quality of the cost-saving studies was slightly, but not significantly, lower than those showing cost increases (85% vs 88%, p=0.460). Conclusions This comprehensive review identified many CIM economic evaluations missed by previous reviews and emerging evidence of cost-effectiveness and possible cost savings in at least a few clinical populations. Recommendations are made for future studies. PMID:22945962

  14. Development of the radial dose distribution function relevant to the treatment planning system for heavy particle cancer therapy

    NASA Astrophysics Data System (ADS)

    Moribayashi, Kengo

    2015-05-01

    This paper presents a study of the radial dose due to the irradiation of a heavy ion, through simulations using a selection of types of atomic and molecular (AM) data. In order to widely spread our radial dose simulation results, a simple radial dose distribution function is proposed. This required a comparison of our results with the available conventional radial dose distributions. It is also shown that the treatment planning system for heavy particle cancer therapy is expected to become one of the most important applications of AM data to biological and medical science.

  15. Pyomyositis Causing Temporary Quadriparesis During Induction Therapy for Acute Lymphoblastic Leukemia: Case Report and Review of the Literature.

    PubMed

    Montazeri, Nazanin; Athale, Uma H; Fulford, Martha; Tarnopolsky, Mark A

    2015-04-01

    Pyomyositis (PM) is a purulent infection of skeletal muscle. It is often associated with immunosuppression in temperate climates. Herein, we report a case of PM causing temporary quadriparesis in a 14-year-old girl undergoing induction therapy for acute lymphoblastic leukemia and we review the reported pediatric cases associated with induction therapy for hematologic malignancies. Early symptoms of PM can be mistaken for the side effects of chemotherapeutic agents. Greater awareness of the clinical picture of PM will aid in early diagnosis and treatment. With appropriate medical therapy and timely abscess drainage, morbidity and mortality is greatly reduced. PMID:24755835

  16. The Efficacy of Exercise Therapy in Reducing Shoulder Pain Related to Breast Cancer: A Systematic Review

    PubMed Central

    Tatham, Barbara; Cheifetz, Oren; Gillespie, Jessica; Snowden, Katie; Temesy, Jessica; Vandenberk, Lisa

    2013-01-01

    ABSTRACT Purpose: Recent research indicates that physiotherapy interventions, such as exercise and manual therapy, may be effective in decreasing the frequency of side effects linked with breast cancer treatment, including fatigue, pain, nausea, and decreased quality of life. This systematic review aims to determine the efficacy of exercise therapy in reducing shoulder pain related to breast cancer treatment and to identify outcome measures that can be used to assess shoulder pain in this population. Methods: A systematic review of the current literature was conducted using portals such as the Physiotherapy Evidence Database (PEDro), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Ovid MEDLINE (1996 to April 2011), and Allied and Complementary Medicine (AMED) (1985 to April 2011). Databases were searched for relevant studies published up to April 2011. Participants in relevant studies were adults (?18 years of age) with a primary diagnosis of breast cancer at any point during the treatment of their disease. Results: Six articles were independently appraised by two blinded reviewers. Six studies met the inclusion criteria, each analyzing different types of exercise—shoulder/arm/scapular strengthening/stabilization, postural exercises, general exercises and conditioning, shoulder range-of-motion exercises, and lymphedema exercises—with respect to their efficacy in reducing shoulder pain related to breast cancer treatment. Conclusions: Results suggest that exercise targeting shoulder pain related to breast cancer treatment may be effective. However, definitive conclusions cannot be drawn due to the lack of methodological quality and homogeneity of the studies included. Clinicians should use valid outcome measures, such as the visual analogue scale and brief pain inventory, to evaluate the effectiveness of this treatment. PMID:24396158

  17. Assessment of potential advantages of relevant ions for particle therapy: A model based study

    SciTech Connect

    Grün, Rebecca; Friedrich, Thomas; Krämer, Michael; Scholz, Michael; Zink, Klemens; Durante, Marco; Engenhart-Cabillic, Rita

    2015-02-15

    Purpose: Different ion types offer different physical and biological advantages for therapeutic applications. The purpose of this work is to assess the advantages of the most commonly used ions in particle therapy, i.e., carbon ({sup 12}C), helium ({sup 4}He), and protons ({sup 1}H) for different treatment scenarios. Methods: A treatment planning analysis based on idealized target geometries was performed using the treatment planning software TRiP98. For the prediction of the relative biological effectiveness (RBE) that is required for biological optimization in treatment planning the local effect model (LEM IV) was used. To compare the three ion types, the peak-to-entrance ratio (PER) was determined for the physical dose (PER{sub PHY} {sub S}), the RBE (PER{sub RBE}), and the RBE-weighted dose (PER{sub BIO}) resulting for different dose-levels, field configurations, and tissue types. Further, the dose contribution to artificial organs at risk (OAR) was assessed and a comparison of the dose distribution for the different ion types was performed for a patient with chordoma of the skull base. Results: The study showed that the advantages of the ions depend on the physical and biological properties and the interplay of both. In the case of protons, the consideration of a variable RBE instead of the clinically applied generic RBE of 1.1 indicates an advantage in terms of an increased PER{sub RBE} for the analyzed configurations. Due to the fact that protons show a somewhat better PER{sub PHY} {sub S} compared to helium and carbon ions whereas helium shows a higher PER{sub RBE} compared to protons, both protons and helium ions show a similar RBE-weighted dose distribution. Carbon ions show the largest variation of the PER{sub RBE} with tissue type and a benefit for radioresistant tumor types due to their higher LET. Furthermore, in the case of a two-field irradiation, an additional gain in terms of PER{sub BIO} is observed when using an orthogonal field configuration for carbon ions as compared to opposing fields. In contrast, for protons, the PER{sub BIO} is almost independent on the field configuration. Concerning the artificial lateral OAR, the volume receiving 20% of the prescribed RBE-weighted dose (V20) was reduced by over 35% using helium ions and by over 40% using carbon ions compared to protons. The analysis of the patient plan showed that protons, helium, and carbon ions are similar in terms of target coverage whereas the dose to the surrounding tissue is increasing from carbon ions toward protons. The mean dose to the brain stem can be reduced by more than 55% when using helium ions and by further 25% when using carbon ions instead of protons. Conclusions: The comparison of the PER{sub RBE} and PER{sub PHY} {sub S} of the three ion types suggests a strong dependence of the advantages of the three ions on the dose-level, tissue type, and field configuration. In terms of conformity, i.e., dose to the normal tissue, a clear gain is expected using carbon or helium ions compared to protons.

  18. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review

    PubMed Central

    Arnal-Gómez, Anna; Arbós-Berenguer, Teresa; González, Ángel Arturo López; Vicente-Herrero, Teófila

    2014-01-01

    Background: Tension-type headache (TTH) is a disease with a great incidence on quality of life and with a significant socioeconomic impact. Objectives: The aim of this review is to determine the effectiveness of physical therapy by using manual therapy (MT) for the relief of TTH. Data sources: A review was done identifying randomized controlled trials through searches in MEDLINE, PEDro, Cochrane and CINAHL (January 2002 – April 2012). Study selection: English-language studies, with adult patients and number of subjects not under 11, diagnosed with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) were included. Data extraction: Initial search was undertaken with the words Effectiveness, Tension-type headache, and Manual therapy (39 studies). In addition, a search which included terms related to treatments such as physiotherapy, physical therapy, spinal manipulation was performed (25 studies). Results: From the two searches 9 studies met the inclusion criteria and were analysed finding statistically significant results: 1) myofascial release, cervical traction, neck muscles trigger points in cervical thoracic muscles and stretching; 2) Superficial heat and massage, connective tissue manipulation and vertebral Cyriax mobilization; 3) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction; 4) massage, progressive relaxation and gentle stretching, program of active exercises of shoulder, neck and pericranial muscles; 5) massage, passive rhythmic mobilization techniques, cervical, thoracic and lumbopelvic postural correction and cranio-cervical exercises; 6) progressive muscular relaxation combined with joint mobilization, functional, muscle energy, and strain/counterstrain techniques, and cranial osteopathic treatment; 7) massage focused on relieving myofascial trigger point activity; 8) pressure release and muscle energy in suboccipital muscles; 9) combination of mobilizations of the cervical and thoracic spine, exercises and postural correction. All studies used a combination of different techniques and none analyzed treatments separately, also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain. Conclusions: The findings from these studies showed evidence that physiotherapy with articulatory MT, combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH. No evidence was found of the effectiveness of the techniques applied separately. PMID:25792906

  19. Mineral derivatives in alleviating oral mucositis during cancer therapy: a systematic review

    PubMed Central

    2015-01-01

    Objectives. Oral mucositis (mouth ulcers) is a cancer therapy side effect. Costly treatment interventions are often neglected in favor of cost-effective agents. This review assessed the general efficacy of mineral derivatives (a cost-effective agent) in alleviating oral mucositis (OM) during cancer therapy compared to the standard care, or placebo—including a decision tree to aide healthcare workers. Data Sources. Electronic searches of MEDLINE via OVID, EMBASE, CENTRAL, CANCERLIT via PubMed, and CINAHL via EBSCO (year 2000 to 11 September 2014) were undertaken for randomised controlled trials. A meta-search strategy extracted content from aggregate online databases. Review Methods. Randomized controlled trials were assessed (participants, intervention, outcome, results, and risk of bias) for inclusion. The author abstracted binary and continuous data synthesised to Hedges’ g in a random effects model. The primary outcome measures were severity (incidence of peak oral mucositis, duration of oral mucositis, and time to onset); secondary outcome measures were the incidence of pain, and analgesic use. Serum mineral levels, total parenteral nutrition, and adverse events were discussed. The decision tree was mapped using sensitivity, specificity, pre-test and post-test Bayesian probability. Results. 1027 citations were identified and 16 studies were included (n = 1120; mean age 49 years). Cancer therapies consisted of chemotherapy, radiotherapy, chemo-radiotherapy, or hematopoietic stem cell transplantation. Outcome mineral derivatives were zinc (n = 549), calcium phosphate (n = 227), povidone-iodine (n = 228), or selenium (n = 116). Severity was measured across variable OM grading systems: In 13 studies, individuals in treatment groups (n = 958) experienced peak OM less than controls (g = ?0.47, 95% CI ?0.7 to ?0.2, p = 0.0006); time to OM onset was significantly delayed in treatment than controls (g = ?0.51, 95% CI?0.8 to ?0.2, p = 0.0002; five studies); OM mean duration, pain incidences, or analgesics use was not significant. The decision analysis favored selenium. Conclusion. The general positive effect trend suggests individuals taking mineral derivatives during cancer therapies are less likely to experience peak OM than those without. However, significant bias and heterogeneity indicates the need for developing further methods in account of diverse protocols and include novel recordings (serum mineral levels and cell signals) in estimating a uniform true effect. PMID:25699212

  20. Sleep Disturbances in Individuals with Alcohol-Related Disorders: A Review of Cognitive-Behavioral Therapy for Insomnia (CBT-I) and Associated Non-Pharmacological Therapies

    PubMed Central

    Brooks, Alyssa T; Wallen, Gwenyth R

    2014-01-01

    Sleep disturbances are common among alcohol-dependent individuals and are often associated with relapse. The utility of behavioral therapies for sleep disturbances, including cognitive-behavioral therapy for insomnia (CBT-I), among those with alcohol-related disorders is not well understood. This review systematically evaluates the evidence of CBT-I and related behavioral therapies applied to those with alcohol-related disorders and accompanying sleep disturbances. A search of four research databases (PubMed, PsycINFO, Embase, and CINAHL Plus) yielded six studies that met selection criteria. Articles were reviewed using Cochrane’s Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. A majority of the studies demonstrated significant improvements in sleep efficiency among behavioral therapy treatment group(s), including but not limited to CBT-I. While behavioral sleep interventions have been successful in varied populations, they may not be utilized to their full potential among those with alcohol-related disorders as evidenced by the low number of studies found. These findings suggest a need for mixed-methods research on individuals’ sleep experience to inform interventions that are acceptable to the target population. PMID:25288884

  1. Critical review of a quantitative study of a specialty in high energy particle physics

    SciTech Connect

    White, D H; Sullivan, D

    1980-01-01

    A review is made of the authors' series of quantitative, historical, and social studies of the weak interactions of elementary particles. A short intellectual history, the quantitative methodology, and a summary of the papers analyzing specific episodes in this field are presented. The social organization of the field is described, and an overall policy for resource management is discussed. 6 figures, 3 tables.

  2. PHYSICAL REVIEW C 83, 045801 (2011) Trojan horse particle invariance studied with the 6

    E-print Network

    Bertulani, Carlos A. - Department of Physics and Astronomy, Texas A&M University

    2011-01-01

    PHYSICAL REVIEW C 83, 045801 (2011) Trojan horse particle invariance studied with the 6 Li(d,)4 He manuscript received 4 March 2011; published 11 April 2011) The Trojan horse nucleus invariance for the binary reaction cross section extracted from the Trojan horse reaction was tested using the quasifree 3 He(6 Li

  3. EFFECTS OF TEMPERATURE AND PRESSURE ON PARTICLE COLLECTION MECHANISMS: THEORETICAL REVIEW

    EPA Science Inventory

    The report is a critical review and evaluation of the mechanics of aerosols at high temperatures and pressures. It discusses equations and models used to predict particle behavior at normal conditions, with regard to their applicability at high temperatures and pressures. It disc...

  4. Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults

    PubMed Central

    Harris, Petra; Loveman, Emma; Clegg, Andy; Easton, Simon; Berry, Neil

    2015-01-01

    Aim: This systematic review aimed to establish if cognitive behavioural therapy (CBT) can reduce the physical symptoms of chronic headache and migraines in adults. Methods: Evidence from searches of eight databases was systematically sought, appraised and synthesised. Screening of title and abstracts was conducted independently by two reviewers. Full papers were screened, data extracted and quality assessed by one reviewer and checked by a second. Data were synthesised narratively by intervention due to the heterogeneity of the studies. The inclusion criteria specified randomised controlled trials with CBT as an intervention in adults suffering from chronic headaches/migraines not associated with an underlying pathology/medication overuse. CBT was judged on the basis of authors describing the intervention as CBT. The diagnosis of the condition had to be clinician verified. Studies had to include a comparator and employ headache/migraine-specific outcomes such as patient-reported headache days. Results: Out of 1126 screened titles and abstracts and 20 assessed full papers, 10 studies met the inclusion criteria of the review. Some studies combined CBT with another intervention, as well as employing varying numbers of comparators. CBT was statistically significantly more effective in improving some headaches-related outcomes in CBT comparisons with waiting lists (three studies), in combination with relaxation compared with relaxation only (three studies) or antidepressant medication (one study), with no statistically significant differences in three studies. Conclusions: The findings of this review were mixed, with some studies providing evidence in support of the suggestion that people experiencing headaches or migraines can benefit from CBT, and that CBT can reduce the physical symptoms of headache and migraines. However, methodology inadequacies in the evidence base make it difficult to draw any meaningful conclusions or to make any recommendations. PMID:26526604

  5. A Systematic Review of Cellular Transplantation Therapies for Spinal Cord Injury

    PubMed Central

    Okon, Elena B.; Karimi-Abdolrezaee, Soheila; Hill, Caitlin E.; Sparling, Joseph S.; Plemel, Jason R.; Plunet, Ward T.; Tsai, Eve C.; Baptiste, Darryl; Smithson, Laura J.; Kawaja, Michael D.; Fehlings, Michael G.; Kwon, Brian K.

    2011-01-01

    Abstract Cell transplantation therapies have become a major focus in pre-clinical research as a promising strategy for the treatment of spinal cord injury (SCI). In this article, we systematically review the available pre-clinical literature on the most commonly used cell types in order to assess the body of evidence that may support their translation to human SCI patients. These cell types include Schwann cells, olfactory ensheathing glial cells, embryonic and adult neural stem/progenitor cells, fate-restricted neural/glial precursor cells, and bone-marrow stromal cells. Studies were included for review only if they described the transplantation of the cell substrate into an in-vivo model of traumatic SCI, induced either bluntly or sharply. Using these inclusion criteria, 162 studies were identified and reviewed in detail, emphasizing their behavioral effects (although not limiting the scope of the discussion to behavioral effects alone). Significant differences between cells of the same “type” exist based on the species and age of donor, as well as culture conditions and mode of delivery. Many of these studies used cell transplantations in combination with other strategies. The systematic review makes it very apparent that cells derived from rodent sources have been the most extensively studied, while only 19 studies reported the transplantation of human cells, nine of which utilized bone-marrow stromal cells. Similarly, the vast majority of studies have been conducted in rodent models of injury, and few studies have investigated cell transplantation in larger mammals or primates. With respect to the timing of intervention, nearly all of the studies reviewed were conducted with transplantations occurring subacutely and acutely, while chronic treatments were rare and often failed to yield functional benefits. PMID:20146557

  6. Does Quality of Radiation Therapy Predict Outcomes of Multicenter Cooperative Group Trials? A Literature Review

    SciTech Connect

    Fairchild, Alysa; Straube, William; Laurie, Fran; Followill, David

    2013-10-01

    Central review of radiation therapy (RT) delivery within multicenter clinical trials was initiated in the early 1970s in the United States. Early quality assurance publications often focused on metrics related to process, logistics, and timing. Our objective was to review the available evidence supporting correlation of RT quality with clinical outcomes within cooperative group trials. A MEDLINE search was performed to identify multicenter studies that described central subjective assessment of RT protocol compliance (quality). Data abstracted included method of central review, definition of deviations, and clinical outcomes. Seventeen multicenter studies (1980-2012) were identified, plus one Patterns of Care Study. Disease sites were hematologic, head and neck, lung, breast, and pancreas. Between 0 and 97% of treatment plans received an overall grade of acceptable. In 7 trials, failure rates were significantly higher after inadequate versus adequate RT. Five of 9 and 2 of 5 trials reported significantly worse overall and progression-free survival after poor-quality RT, respectively. One reported a significant correlation, and 2 reported nonsignificant trends toward increased toxicity with noncompliant RT. Although more data are required, protocol-compliant RT may decrease failure rates and increase overall survival and likely contributes to the ability of collected data to answer the central trial question.

  7. The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature

    PubMed Central

    Gleberzon, Brian J.; Arts, Jenna; Mei, Amanda; McManus, Emily L.

    2012-01-01

    Introduction This study had two purposes. These were: (i) to conduct a search of the literature between 2007 and 2011 investigating the use of spinal manipulative therapy (SMT) for pediatric health conditions and (ii) to perform a systematic review of eligible retrieved clinical trials. Methods The Index of Chiropractic Literature and PubMed were electronically searched using appropriate search words and MeSH terms, respectively, as well as reference tracking of previous reviews. Studies that met the inclusion criteria were evaluated using an instrument that assessed their methodological quality. Results Sixteen clinical trials were found that met the inclusion criteria and were scored. Discussion Six clinical trials investigated the effectiveness of SMT on colic, two each on asthma and enuresis, and one each on hip extension, otitis media, suboptimal breastfeeding, autism, idiopathic scoliosis and jet lag. None investigated the effectiveness of SMT on spinal pain. Conclusion Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma. Many studies reviewed suffered from several methodological limitations. Further research is clearly required in this area of chiropractic health care, especially with respect to the clinical effectiveness of SMT on pediatric back pain. PMID:22675226

  8. Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence.

    PubMed

    Karagülle, Mine; Karagülle, Müfit Zeki

    2015-02-01

    In most European countries, balneotherapy and spa therapy are widely prescribed by physicians and preferred by European citizens for the treatment of musculoskeletal problems including chronic low back pain (LBP). We aimed to review and evaluate the recent evidence on the effectiveness of balneotherapy and spa therapy for patients with LBP. We comprehensively searched data bases for randomized controlled trials (RCTs) published in English between July 2005 and December 2013. We identified all trials testing balneotherapy or spa therapy for LBP that reported that the sequence of allocation was randomized. We finally included total of eight RCTs: two on balneotherapy and six on spa therapy. All reviewed trials reported that balneotherapy was superior in long term to tap water therapy in relieving pain and improving function and that spa therapy combining balneotherapy with mud pack therapy and/or exercise therapy, physiotherapy, and/or education was effective in the management of low back pain and superior or equally effective to the control treatments in short and long terms. We used Jadad scale to grade the methodological quality. Only three out of total eight had a score of above 3 indicating the good quality. The data from the RCTs indicates that overall evidence on effectiveness of balneotherapy and spa therapy in LBP is encouraging and reflects the consistency of previous evidence. However, the overall quality of trials is generally low. Better quality RCTs (well designed, conducted, and reported) are needed testing short- and long-term effects for relieving chronic back pain and proving broader beneficial effects. PMID:25535198

  9. Trans-arterial embolisation therapies for unresectable intrahepatic cholangiocarcinoma: a systematic review

    PubMed Central

    Yang, Linda; Shan, Jocelyn; Shan, Leonard; Bester, Lourens; Morris, David L.

    2015-01-01

    Background Unresectable intrahepatic cholangiocarcinoma (ICC) portends a poor prognosis despite standard systemic treatments which confer minimal survival benefits and significant adverse effects. This study aimed to assess clinical outcomes, complications and prognostic factors of TAE therapies using chemotherapeutic agents or radiation. Methods A literature search and article acquisition was conducted on PubMed (MEDLINE), OVID (MEDLINE) and EBSCOhost (EMBASE). Original articles published after January 2000 on trans-arterial therapies for unresectable ICC were selected using strict eligibility criteria. Radiological response, overall survival, progression-free survival, safety profile, and prognostic factors for overall survival were assessed. Quality appraisal and data tabulation were performed using pre-determined forms. Results were synthesized by narrative review and quantitative analysis. Results Twenty articles were included (n=929 patients). Thirty three percent of patients presented with extrahepatic metastases. After treatment, the average rate of complete and partial radiological response was 10% and 22.2%, respectively. Overall median survival time was 12.4 months with a median 30-day mortality and 1-year survival rate of 0.6% and 53%, respectively. Acute treatment toxicity (within 30 days) was reported in 34.9% of patients, of which 64.3% were mild to moderate in severity. The most common clinical toxicities were abdominal pain, nausea and vomiting, and fatigue. Multiplicity, localization and vascularity of the tumor may predict worse overall survival. Conclusions Trans-arterial therapies are safe and effective treatment options which should be considered routinely for unresectable ICC. Consistent and standardized methodology and data collection is required to facilitate a meta-analysis. Randomized controlled trials will be valuable in the future. PMID:26487951

  10. Thyroid tumor-initiating cells: Increasing evidence and opportunities for anticancer therapy (Review)

    PubMed Central

    GAO, YONG-JU; LI, BO; WU, XIN-YU; CUI, JING; HAN, JIAN-KUI

    2014-01-01

    Accumulating evidence supports the notion that thyroid cancer is initiated by tumor-initiating cells (TICs) (commonly known as cancer stem cells), which are thought to play a crucial role in malignant progression, therapeutic resistance and recurrence. Thyroid TICs have been isolated and identified using specific biomarkers (such as CD133), the side population, sphere formation and aldehyde dehydrogenase activity assays. Although their characteristics remain largely unknown, TICs provide an attractive cellular mechanism to explain therapeutic refractoriness. Efforts are currently being directed toward the identification of therapeutic strategies that could target these cells. The present review discusses the cellular origins of TICs and the main approaches used to isolate and identify thyroid TICs, with a focus on the remaining challenges and opportunities for anticancer therapy. PMID:24424445

  11. The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis.

    PubMed

    Ost, Lars-Göran

    2014-10-01

    Acceptance and Commitment therapy (ACT) has attracted a lot of interest during the last 10-15 years with a strong increase of the number of randomized controlled trials (RCTs). The present review and meta-analysis includes 60 RCTs (4234 participants) on psychiatric disorders, somatic disorders, and stress at work. The mean effect size across all comparisons was small (0.42). Compared to the Öst (2008) meta-analysis there was no significant improvement in methodological quality and deterioration in effect size (from 0.68). When ACT was compared to various forms of cognitive or behavioral treatments a small and non-significant effect size of 0.16 was obtained. An evidence-base evaluation showed that ACT is not yet well-established for any disorder. It is probably efficacious for chronic pain and tinnitus, possibly efficacious for depression, psychotic symptoms, OCD, mixed anxiety, drug abuse, and stress at work, and experimental for the remaining disorders. PMID:25193001

  12. Nanotechnology-Based Drug Delivery Systems for Melanoma Antitumoral Therapy: A Review

    PubMed Central

    Rigon, Roberta Balansin; Oyafuso, Márcia Helena; Fujimura, Andressa Terumi; do Prado, Alice Haddad; Gremião, Maria Palmira Daflon

    2015-01-01

    Melanoma (MEL) is a less common type of skin cancer, but it is more aggressive with a high mortality rate. The World Cancer Research Fund International (GLOBOCAN 2012) estimates that there were 230,000 new cases of MEL in the world in 2012. Conventional MEL treatment includes surgery and chemotherapy, but many of the chemotherapeutic agents used present undesirable properties. Drug delivery systems are an alternative strategy by which to carry antineoplastic agents. Encapsulated drugs are advantageous due to such properties as high stability, better bioavailability, controlled drug release, a long blood circulation time, selective organ or tissue distribution, a lower total required dose, and minimal toxic side effects. This review of scientific research supports applying a nanotechnology-based drug delivery system for MEL therapy. PMID:26078967

  13. Review of treatment assessment using DCE-MRI in breast cancer radiation therapy

    PubMed Central

    Wang, Chun-Hao; Yin, Fang-Fang; Horton, Janet; Chang, Zheng

    2014-01-01

    As a noninvasive functional imaging technique, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is being used in oncology to measure properties of tumor microvascular structure and permeability. Studies have shown that parameters derived from certain pharmacokinetic models can be used as imaging biomarkers for tumor treatment response. The use of DCE-MRI for quantitative and objective assessment of radiation therapy has been explored in a variety of methods and tumor types. However, due to the complexity in imaging technology and divergent outcomes from different pharmacokinetic approaches, the method of using DCE-MRI in treatment assessment has yet to be standardized, especially for breast cancer. This article reviews the basic principles of breast DCE-MRI and recent studies using DCE-MRI in treatment assessment. Technical and clinical considerations are emphasized with specific attention to assessment of radiation treatment response. PMID:25332905

  14. Duration of Dual Antiplatelet Therapy After Coronary Stenting: A Review of the Evidence.

    PubMed

    Montalescot, Gilles; Brieger, David; Dalby, Anthony J; Park, Seung-Jung; Mehran, Roxana

    2015-08-18

    The duration of dual antiplatelet therapy (DAPT) after coronary stenting has been evaluated in randomized studies with apparently conflicting results. Although longer exposure associates with more bleeding complications, late stent thrombosis (ST) and myocardial infarction are reduced. In addition, as new drug-eluting stents carry a lower risk of ST compared with the first-generation drug-eluting stents and possibly even bare-metal stents, a shift toward better protection from ST may have an effect on the duration and intensity of DAPT. Whether the duration of DAPT should be shorter or longer than the currently recommended 6 to 12 months is analyzed in this review, drawing on lessons from the most recent studies. PMID:26271067

  15. Racial/Ethnic and socioeconomic disparities in endocrine therapy adherence in breast cancer: a systematic review.

    PubMed

    Roberts, Megan C; Wheeler, Stephanie B; Reeder-Hayes, Katherine

    2015-07-01

    We examined the current literature to understand factors that influence endocrine therapy (ET) adherence among racial/ethnic and socioeconomic subpopulations of breast cancer patients. We searched PubMed and PsycINFO databases for studies from January 1, 1978, to June 20, 2014, and January 1, 1991, to June 20, 2014, respectively, and hand-searched articles from relevant literature reviews. We abstracted and synthesized results within a social ecological framework. Fourteen articles met all inclusion criteria. The majority of included articles reported significant underuse of ET among minority and low-income women. Modifiable intrapersonal, interpersonal, and community-level factors are associated with ET use, and these factors vary across subgroups. Both race/ethnicity and socioeconomic status are associated with ET use in most settings. Variation in factors associated with ET use across subgroups indicates the need for more nuanced research and targeted interventions among breast cancer patients. PMID:25905855

  16. Nutrition therapy in critically ill patients- a review of current evidence for clinicians.

    PubMed

    Ridley, Emma; Gantner, Dashiell; Pellegrino, Vincent

    2015-08-01

    The provision of nutrition to critically ill patients is internationally accepted as standard of care in intensive care units (ICU). Nutrition has the potential to positively impact patient outcomes, is relatively inexpensive compared to other commonly used treatments, and is increasingly identified as a marker of quality ICU care. Furthermore, we are beginning to understand its true potential, with positive and deleterious consequences when it is delivered inappropriately. As with many areas of medicine the evidence is rapidly changing and often conflicting, making interpretation and application difficult for the individual clinician. This narrative review aims to provide an overview of the major evidence base on nutrition therapy in critically ill patients and provide practical suggestions. PMID:25616601

  17. Review of dermatology use of 5-aminolevulinic acid photodynamic therapy in China from 1997 to 2013

    NASA Astrophysics Data System (ADS)

    Wang, Peiru; Zhang, Guolong; Wang, Xiuli

    2015-07-01

    The prodrug 5-aminolevulinic acid (ALA) and its ester derivatives have been used in photodynamic therapy (PDT) in dermatology worldwide. In China, ALA-PDT was first used to treat urethral condylomata acuminata and non-melanoma skin cancers in 1997. A powder formulation of ALA hydrochloride was approved by the Chinese Food and Drug Administration for the treatment of condylomata acuminata in 2007. Large successful experience of treating condylomatas was accumulated compared with Western countries. Meanwhile, numerous clinical studies as well as off-label use of ALAPDT have been carried out in China. To reflect the progress of ALA-PDT in China, several major Chinese and English databases were searched and published data were reviewed in this article.

  18. HERBAL THERAPY USE BY CANCER PATIENTS: A LITERATURE REVIEW ON CASE REPORTS

    PubMed Central

    Olaku, Oluwadamilola; White, Jeffrey D.

    2011-01-01

    Complementary and alternative medicine use is common among cancer patients. In many surveys, herbal medicines are among the most commonly used group of treatments. Herbal remedies are believed by the general public to be safe, cause less side effects and less likely to cause dependency. The authors performed a literature review to assess which herbal approaches have had associated cancer case reports and determine which of these have been studied in prospective research. Eighteen case reports of patients having apparent antitumour effects from herbal therapy and 21 case reports of toxic effects of herbs used by cancer patients were identified. Clinicaltrials.gov and MEDLINE (via PubMed) were searched for each of the herbal products identified in these reports. Clinical trials in cancer populations were identified for green tea extracts or compounds (n = 34), phytoestrogens (n=27), mistletoe (n =8), Ganoderma lucidum (n=1), Noni (n = 1) and Silymarin (n = 1). Daikenchuto, PC-SPES, Nyoshinsan/TJ and Saw palmetto have also been studied prospectively. In conclusion, some of the herbs with promising case report findings have undergone prospective clinical investigations but many others have either not yet been explored or the results have not been reported in English. Unconventional therapies, such as herbs and minerals, used in ancient medical traditions have led to the identification of active anticancer agents. Mechanisms to support prospective research with such approaches are discussed. PMID:21185719

  19. Systematic review of therapies for noncyclic chronic pelvic pain in women.

    PubMed

    Yunker, Amanda; Sathe, Nila A; Reynolds, William Stuart; Likis, Frances E; Andrews, Jeff

    2012-07-01

    We synthesized the literature (articles published between 1990 and May 2011) on the treatment of noncyclic and mixed cyclic/noncyclic chronic pelvic pain (CPP) in adult women. Two reviewers assessed studies against predetermined inclusion/exclusion criteria, extracted data regarding participant and intervention characteristics and outcomes, and assigned overall quality and strength of evidence ratings. Of 2081 studies, 21 addressed surgical or nonsurgical interventions. Definitions of CPP and participant characteristics varied across studies, and most studies were of poor quality, which precluded data synthesis. Although surgical and nonsurgical approaches both improved pain, neither was more effective when directly compared in 3 studies. Laparoscopic adhesiolysis or laparoscopic uterosacral nerve ablation did not further improve pain scores over diagnostic laparoscopy. The evidence to conclude that surgical intervention is either effective or ineffective or that one technique is superior to another is insufficient. Most studies on nonsurgical approaches evaluated hormonal therapies in endometriosis-associated CPP and were not placebo controlled. Few studies addressed nonhormonal or nonpharmacologic approaches. Harms reporting was limited. Overall, no nonsurgical treatment was more or less effective than another, except for the clear negative effect of raloxifene. In general, the literature addressing therapies for CPP in women is of poor quality and inconclusive. Improved characterizations of the targeted condition and interventions in CPP research, including a uniform definition and standardized evaluation, are necessary to inform treatment choices. PMID:22926248

  20. Experimental use of photodynamic therapy in high grade gliomas: a review focused on 5-aminolevulinic acid.

    PubMed

    Tetard, Marie-Charlotte; Vermandel, Maximilien; Mordon, Serge; Lejeune, Jean-Paul; Reyns, Nicolas

    2014-09-01

    Photodynamic therapy (PDT) consists of a laser light exposure of tumor cells photosensitized by general or local administration of a pharmacological agent. Nowadays, PDT is a clinically established modality for treatment of many cancers. 5-Aminolevulinic acid (ALA) induced protoporphyrin IX (PpIX) has proven its rational in fluoro-guided resection of malignant gliomas due to a selective tumor uptake and minimal skin sensitization. Moreover, the relatively specific accumulation of photosensitizing PPIX within the tumor cells has gained interest in the PDT of malignant gliomas. Several experimental and clinical studies have then established ALA-PDT as a valuable adjuvant therapy in the management of malignant gliomas. However, the procedure still requires optimizations in the fields of tissue oxygenation status, photosensitizer concentration or scheme of laser light illumination. In this extensive review, we focused on the methods and results of ALA-PDT for treating malignant gliomas in experimental conditions. The biological mechanisms, the effects on tumor and normal brain tissue, and finally the critical issues to optimize the efficacy of ALA-PDT were discussed. PMID:24905843

  1. Molecular-targeted therapy for chemotherapy-refractory gastric cancer: a case report and literature review.

    PubMed

    Kuo, Hung-Yang; Yeh, Kun-Huei

    2014-07-01

    The prognosis of advanced gastric cancer (AGC) remains poor despite therapeutic advances in recent decades. Several recent positive phase III trials established the efficacy of second-line chemotherapy for metastatic gastric cancer in prolonging overall survival. However, malnutrition and poor performance of AGC in late stages usually preclude such patients from intensive treatment. Many targeted-therapies failed to show a significant survival benefit in AGC, but have regained attention after the positive result of ramucirumab was announced last year. Among all targeted agents, only trastuzumab, a monoclonal antibody against Human epidermal growth factor receptor-2 (HER2) protein, has been proven as having survival benefit by addition to first-line chemotherapy. Herein we reported a patient who benefited from adding trastuzumab to the same second-line combination chemotherapy (paclitaxel, 5-fluorouracil, and leucovorin) upon progression of bulky liver metastases. At least five months of progression-free survival were achieved without any additional toxicity. We also reviewed literature of molecularly-targeted therapy for chemotherapy-refractory gastric cancer, including several large phase III trials (REGARD, GRANITE-1, EXPAND, and REAL-3) published in 2013-2014. PMID:24982389

  2. The levonorgestrel-releasing intrauterine system for endometrial protection during estrogen replacement therapy: a clinical review.

    PubMed

    Depypere, H; Inki, P

    2015-01-01

    Estrogen replacement therapy (ERT) is a well-established method of managing climacteric symptoms in women approaching the menopause, but it is associated with a significant risk of endometrial hyperplasia if unopposed by concomitant progestogen administration. The levonorgestrel-releasing intrauterine system (LNG-IUS) offers a highly effective method of minimizing this risk and has additional benefits beyond endometrial protection. The LNG-IUS provides excellent contraception, which may still be necessary in perimenopausal women, and is suitable for women with underlying conditions that may preclude their use of estrogen-containing contraceptive methods. It can effectively manage bleeding problems through the transition from perimenopause into menopause, with many women developing amenorrhea. The LNG-IUS is well tolerated with a favorable safety profile, which generally mirrors that of women of reproductive age using it for contraception only. Moreover, the LNG-IUS plus ERT combination does not appear to be associated with clinically relevant effects on plasma lipids or other markers of cardiovascular risk. Women using the LNG-IUS plus ERT also experience improvements in quality of life, and adherence and continuation rates are high. This review will summarize the clinical evidence for the use of the LNG-IUS plus ERT in peri- and postmenopausal women and present the key attributes of this combined therapy. PMID:25553775

  3. A Narrative Review of Yoga and Mindfulness as Complementary Therapies for Addiction

    PubMed Central

    Khanna, Surbhi; Greeson, Jeffrey M.

    2013-01-01

    Summary This paper reviews the philosophical origins, current scientific evidence, and clinical promise of yoga and mindfulness as complementary therapies for addiction. Historically, there are eight elements of yoga that, together, comprise ethical principles & practices for living a meaningful, purposeful, moral and self-disciplined life. Traditional yoga practices, including postures and meditation, direct attention towards one’s health, while acknowledging the spiritual aspects of one’s nature. Mindfulness derives from ancient Buddhist philosophy, and mindfulness meditation practices, such as gentle Hatha yoga and mindful breathing, are increasingly integrated into secular health care settings. Current theoretical models suggest that the skills, insights, and self-awareness learned through yoga and mindfulness practice can target multiple psychological, neural, physiological, and behavioral processes implicated in addiction and relapse. A small but growing number of well-designed clinical trials and experimental laboratory studies on smoking, alcohol dependence, and illicit substance use support the clinical effectiveness and hypothesized mechanisms of action underlying mindfulness-based interventions for treating addiction. Because very few studies have been conducted on the specific role of yoga in treating or preventing addiction, we propose a conceptual model to inform future studies on outcomes and possible mechanisms. Additional research is also needed to better understand what types of yoga and mindfulness-based interventions work best for what types of addiction, what types of patients, and under what conditions. Overall, current findings increasingly support yoga and mindfulness as promising complementary therapies for treating and preventing addictive behaviors. PMID:23642957

  4. Physical therapy in heart failure with preserved ejection fraction: A systematic review.

    PubMed

    Palau, Patricia; Núñez, Eduardo; Domínguez, Eloy; Sanchis, Juan; Núñez, Julio

    2016-01-01

    About 50% of patients with heart failure (HF) have preserved ejection fraction (HFpEF) which is especially common in elderly people with highly prevalent co-morbid conditions. HFpEF is usually defined as an ejection fraction equal to or greater than 50%, although some studies have used a limit as low as 40%. The prevalence of this syndrome is expected to increase over the next decades. The associated impact on mortality and hospital readmissions has made of this entity a major public health issue. Despite the fact that mortality and re-hospitalisation rates of HFpEF are similar to the syndrome of HF with reduced ejection fraction (HFrEF), currently there is no available evidence-based therapy as effective as is the case for HFrEF. Exercise intolerance is the principal clinical feature in HFpEF. The pathophysiological mechanisms behind impaired exercise capacity in these patients are complex and not yet fully elucidated. Current guidelines and consensus documents recommend the implementation of exercise training in HFpEF; however, they are based mostly on results from a few small trials evaluating surrogate endpoints such as exercise capacity and quality of life. The aim of this work was to review the current evidence that supports the effect of the different modalities of physical therapies in HFpEF. PMID:25488549

  5. Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review

    PubMed Central

    2013-01-01

    Objective The aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries. Methods Thirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords ‘ankle*’, ‘robot*’, ‘rehabilitat*’ or ‘treat*’ and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation. Results Twenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being II. Conclusion All the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies. PMID:23517734

  6. Photothermal cancer therapy using graphitic carbon–coated magnetic particles prepared by one-pot synthesis

    PubMed Central

    Lee, Hyo-Jeong; Sanetuntikul, Jakkid; Choi, Eun-Sook; Lee, Bo Ram; Kim, Jung-Hee; Kim, Eunjoo; Shanmugam, Sangaraju

    2015-01-01

    We describe here a simple synthetic strategy for the fabrication of carbon-coated Fe3O4 (Fe3O4@C) particles using a single-component precursor, iron (III) diethylenetriaminepentaacetic acid complex. Physicochemical analyses revealed that the core of the synthesized particles consists of ferromagnetic Fe3O4 material ranging several hundred nanometers, embedded in nitrogen-doped graphitic carbon with a thickness of ~120 nm. Because of their photothermal activity (absorption of near-infrared [NIR] light), the Fe3O4@C particles have been investigated for photothermal therapeutic applications. An example of one such application would be the use of Fe3O4@C particles in human adenocarcinoma A549 cells by means of NIR-triggered cell death. In this system, the Fe3O4@C can rapidly generate heat, causing >98% cell death within 10 minutes under 808 nm NIR laser irradiation (2.3 W cm?2). These Fe3O4@C particles provided a superior photothermal therapeutic effect by intratumoral delivery and NIR irradiation of tumor xenografts. These results demonstrate that one-pot synthesis of carbon-coated magnetic particles could provide promising materials for future clinical applications and encourage further investigation of this simple method. PMID:25565819

  7. Effectiveness of Cognitive Behavioral and Supportive-Expressive Group Therapy for Women Diagnosed with Breast Cancer: A Review of the Literature

    ERIC Educational Resources Information Center

    Boutin, Daniel L.

    2007-01-01

    A review of the literature revealed 20 studies that examined the extent to which cognitive behavioral therapy (CBT), supportive-expressive group therapy (SEGT), and a combination of these two treatments impact women with breast cancer. Based on this review, it is determined that CBT and SEGT have repeated experimental support for positively…

  8. A review of stereotactic body radiotherapy – is volumetric modulated arc therapy the answer?

    SciTech Connect

    Sapkaroski, Daniel Osborne, Catherine; Knight, Kellie A

    2015-06-15

    Stereotactic body radiotherapy (SBRT) is a high precision radiotherapy technique used for the treatment of small to moderate extra-cranial tumours. Early studies utilising SBRT have shown favourable outcomes. However, major disadvantages of static field SBRT include long treatment times and toxicity complications. Volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) may potentially mitigate these disadvantages. This review aims to assess the feasibility of emerging VMAT and IMRT-based SBRT treatment techniques and qualify which offers the best outcome for patients, whilst identifying any emerging and advantageous SBRT planning trends. A review and synthesis of data from current literature up to September 2013 was conducted on EMBASE, Medline, PubMed, Science Direct, Proquest central, Google Scholar and the Cochrane Database of Systematic reviews. Only full text papers comparing VMAT and or IMRT and or Static SBRT were included. Ten papers were identified that evaluated the results of VMAT/IMRT SBRT. Five related to medically inoperable stage 1 and 2 non-small-cell lung cancer (NSCLC), three to spinal metastasis, one related to abdominal lymph node malignancies, with the final one looking at pancreatic adenocarcinoma. Overall treatment times with VMAT were reduced by 66–70% for lung, 46–58% for spine, 42% and 21% for lymph node and pancreatic metastasis respectively, planning constraints were met with several studies showing improved organs at risk sparing with IMRT/VMAT to static SBRT. Both IMRT and VMAT were able to meet all planning constraints in the studies reviewed, with VMAT offering the greatest treatment efficiency. Early clinical outcomes with VMAT and IMRT SBRT have demonstrated excellent local control and favourable survival outcomes.

  9. A review of stereotactic body radiotherapy – is volumetric modulated arc therapy the answer?

    PubMed Central

    Sapkaroski, Daniel; Osborne, Catherine; Knight, Kellie A

    2015-01-01

    Stereotactic body radiotherapy (SBRT) is a high precision radiotherapy technique used for the treatment of small to moderate extra-cranial tumours. Early studies utilising SBRT have shown favourable outcomes. However, major disadvantages of static field SBRT include long treatment times and toxicity complications. Volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) may potentially mitigate these disadvantages. This review aims to assess the feasibility of emerging VMAT and IMRT-based SBRT treatment techniques and qualify which offers the best outcome for patients, whilst identifying any emerging and advantageous SBRT planning trends. A review and synthesis of data from current literature up to September 2013 was conducted on EMBASE, Medline, PubMed, Science Direct, Proquest central, Google Scholar and the Cochrane Database of Systematic reviews. Only full text papers comparing VMAT and or IMRT and or Static SBRT were included. Ten papers were identified that evaluated the results of VMAT/IMRT SBRT. Five related to medically inoperable stage 1 and 2 non-small-cell lung cancer (NSCLC), three to spinal metastasis, one related to abdominal lymph node malignancies, with the final one looking at pancreatic adenocarcinoma. Overall treatment times with VMAT were reduced by 66–70% for lung, 46–58% for spine, 42% and 21% for lymph node and pancreatic metastasis respectively, planning constraints were met with several studies showing improved organs at risk sparing with IMRT/VMAT to static SBRT. Both IMRT and VMAT were able to meet all planning constraints in the studies reviewed, with VMAT offering the greatest treatment efficiency. Early clinical outcomes with VMAT and IMRT SBRT have demonstrated excellent local control and favourable survival outcomes. PMID:26229679

  10. Memantine and cholinesterase inhibitor combination therapy for Alzheimer's disease: a systematic review

    PubMed Central

    Farrimond, Lucy E; Roberts, Emmert

    2012-01-01

    Background Memantine is licensed for moderate-to-severe Alzheimer's disease (AD). National Institute for Clinical Excellence (NICE) guidance does not recommend the use of memantine in combination with cholinesterase inhibitors (acetylcholinesterase inhibitor (AChEI)). The underpinning meta-analysis was disputed by the manufacturer. Objectives To compare the efficacy of AChEI monotherapy with combination memantine and AChEI therapy in patients with moderate-to-severe AD and to examine the impact of including unpublished data on the results. Design Systematic review and meta-analysis of randomised controlled trials. Data sources The Cochrane Dementia Group trial register, ALOIS, searched for the last time on 3 May 2011. Data synthesis Data from four domains (clinical global, cognition, function, behaviour and mood) were pooled. Sensitivity analyses examined the impact on the NICE-commissioned meta-analysis of restricting data to patients with moderate-to-severe AD and of including an unpublished trial of an extended release preparation of memantine. Results Pooled data from the trials, which were included in the NICE-commissioned meta-analysis but which were restricted to moderate-to-severe AD only, showed a small effect of combination therapy on cognition (standardised mean difference (SMD)=?0.29, 95% CI ?0.45 to ?0.14). Adding data from an unpublished trial of an extended release memantine (total three trials, 1317 participants) showed a small benefit of combination therapy on global scores (SMD=?0.20, 95% CI ?0.31 to ?0.09), cognition (SMD=?0.25, 95% CI ?0.36 to ?0.14) and behaviour and mood (SMD=?0.17, 95% CI ?0.32 to ?0.03) but not on function (SMD=?0.04, 95% CI ?0.21 to 0.13) at 6?months. No clinical data have been reported from a 1-year trial, although this found ‘no significant benefit’ on any clinical measures at 1?year. Conclusions These results suggest that there may be a small benefit at 6?months of adding memantine to AChEIs. However, the impact on clinical global impression depends on exactly which studies are included, and there is no benefit on function, so its clinical relevance is not robustly demonstrated. Currently available information from randomised controlled trails indicates no benefit of combination therapy over monotherapy at 1?year. Legislation on the form and content of registry posted results is needed in Europe. PMID:22689908

  11. Computerised Cognitive Behavioural Therapy for the Prevention and Treatment of Depression and Anxiety in Children and Adolescents: A Systematic Review

    ERIC Educational Resources Information Center

    Richardson, Thomas; Stallard, Paul; Velleman, Sophie

    2010-01-01

    Research has shown that computerised cognitive behaviour therapy (cCBT) can be effective in the treatment of depression and anxiety in adults, although the outcomes with children and adolescents are unclear. The aim of the study is to systematically review the literature on the effectiveness of cCBT for the prevention and treatment of depression…

  12. Using Cognitive Behavior Therapy in Clinical Work with African American Children and Adolescents: A Review of the Literature

    ERIC Educational Resources Information Center

    Wilson, Courtney J.; Cottone, R. Rocco

    2013-01-01

    A comprehensive review of the literature on clinical work with African American youth with cognitive behavior therapy (CBT) is presented. The strengths and limitations of CBT in relation to this population are outlined. Although CBT shows promise in helping, research on the efficacy and effectiveness of CBT in this group is lacking. (Contains 3…

  13. Arts Therapies for Anxiety, Depression, and Quality of Life in Breast Cancer Patients: A Systematic Review and Meta-Analysis

    PubMed Central

    2014-01-01

    Background. Breast cancer is one of the most common types of cancer. However, only a few trials assess the effects of arts therapies. Material and Methods. We searched the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar from their start date to January 2012. We handsearched reference lists and contacted experts. All randomized controlled trials, quasi-randomized trials, and controlled clinical trials of art interventions in breast cancer patients were included. Data were extracted and risk of bias was assessed. Meta-analyses were performed using standardized mean differences. Results. Thirteen trials with a total of 606 patients were included. Arts therapies comprised music therapy interventions, various types of art therapy, and dance/movement therapies. The methodological quality ranged from poor to high quality with the majority scoring 3 of 4 points on the Jadad scale. Results suggest that arts therapies seem to positively affect patients' anxiety (standardized mean difference: ?1.10; 95%, confidence interval: ?1.40 to ?0.80) but not depression or quality of life. No conclusion could be drawn regarding the effects of arts therapy on pain, functional assessment, coping, and mood states. Discussion. Our review indicates that arts interventions may have beneficial effects on anxiety in patients with breast cancer. PMID:24817896

  14. Evaluation of cytotoxicity and radiation enhancement using 1.9 nm gold particles: potential application for cancer therapy

    PubMed Central

    Butterworth, K T; Coulter, J A; Jain, S; Forker, J; McMahon, S J; Schettino, G; Prise, K M; Currell, F J; Hirst, D G

    2010-01-01

    High atomic number (Z) materials such as gold preferentially absorb kilovoltage x-rays compared to soft tissue and may be used to achieve local dose enhancement in tumours during treatment with ionizing radiation. Gold nanoparticles have been demonstrated as radiation dose enhancing agents in vivo and in vitro. In the present study, we used multiple endpoints to characterize the cellular cytotoxic response of a range of cell lines to 1.9 nm gold particles and measured dose modifying effects following transient exposure at low concentrations. Gold nanoparticles caused significant levels of cell type specific cytotoxicity, apoptosis and increased oxidative stress. When used as dose modifying agents, dose enhancement factors varied between the cell lines investigated with the highest enhancement being 1.9 in AGO-1522B cells at a nanoparticle concentration of 100 ?g ml?1. This study shows exposure to 1.9 nm gold particles to induce a range of cell line specific responses including decreased clonogenic survival, increased apoptosis and induction of DNA damage which may be mediated through the production of reactive oxygen species. This is the first study involving 1.9 nm nanometre sized particles to report multiple cellular responses which impact on the radiation dose modifying effect. The findings highlight the need for extensive characterization of responses to gold nanoparticles when assessing dose enhancing potential in cancer therapy. PMID:20601762

  15. Calculation of radiation therapy dose using all particle Monte Carlo transport

    DOEpatents

    Chandler, William P. (Tracy, CA); Hartmann-Siantar, Christine L. (San Ramon, CA); Rathkopf, James A. (Livermore, CA)

    1999-01-01

    The actual radiation dose absorbed in the body is calculated using three-dimensional Monte Carlo transport. Neutrons, protons, deuterons, tritons, helium-3, alpha particles, photons, electrons, and positrons are transported in a completely coupled manner, using this Monte Carlo All-Particle Method (MCAPM). The major elements of the invention include: computer hardware, user description of the patient, description of the radiation source, physical databases, Monte Carlo transport, and output of dose distributions. This facilitated the estimation of dose distributions on a Cartesian grid for neutrons, photons, electrons, positrons, and heavy charged-particles incident on any biological target, with resolutions ranging from microns to centimeters. Calculations can be extended to estimate dose distributions on general-geometry (non-Cartesian) grids for biological and/or non-biological media.

  16. Calculation of radiation therapy dose using all particle Monte Carlo transport

    DOEpatents

    Chandler, W.P.; Hartmann-Siantar, C.L.; Rathkopf, J.A.

    1999-02-09

    The actual radiation dose absorbed in the body is calculated using three-dimensional Monte Carlo transport. Neutrons, protons, deuterons, tritons, helium-3, alpha particles, photons, electrons, and positrons are transported in a completely coupled manner, using this Monte Carlo All-Particle Method (MCAPM). The major elements of the invention include: computer hardware, user description of the patient, description of the radiation source, physical databases, Monte Carlo transport, and output of dose distributions. This facilitated the estimation of dose distributions on a Cartesian grid for neutrons, photons, electrons, positrons, and heavy charged-particles incident on any biological target, with resolutions ranging from microns to centimeters. Calculations can be extended to estimate dose distributions on general-geometry (non-Cartesian) grids for biological and/or non-biological media. 57 figs.

  17. Vitamin D as an adjunctive therapy in asthma. Part 1: A review of potential mechanisms.

    PubMed

    Kerley, Conor P; Elnazir, Basil; Faul, John; Cormican, Liam

    2015-06-01

    Vitamin D deficiency (VDD) is highly prevalent worldwide. The classical role for vitamin D is to regulate calcium absorption form the gastrointestinal tract and influence bone health. Recently vitamin D receptors and vitamin D metabolic enzymes have been discovered in numerous sites systemically supporting diverse extra-skeletal roles of vitamin D, for example in asthmatic disease. Further, VDD and asthma share several common risk factors including high latitude, winter season, industrialization, poor diet, obesity, and dark skin pigmentation. Vitamin D has been demonstrated to possess potent immunomodulatory effects, including effects on T cells and B cells as well as increasing production of antimicrobial peptides (e.g. cathelicidin). This immunomodulation may lead to asthma specific clinical benefits in terms of decreased bacterial/viral infections, altered airway smooth muscle-remodeling and -function as well as modulation of response to standard anti-asthma therapy (e.g. glucocorticoids and immunotherapy). Thus, vitamin D and its deficiency have a number of biological effects that are potentially important in altering the course of disease pathogenesis and severity in asthma. The purpose of this first of a two-part review is to review potential mechanisms whereby altering vitamin D status may influence asthmatic disease. PMID:25732539

  18. Continuation and Maintenance Electroconvulsive Therapy for Mood Disorders: Review of the Literature

    PubMed Central

    Petrides, Georgios; Tobias, Kristen G.; Kellner, Charles H.; Rudorfer, Matthew V.

    2011-01-01

    Background Electroconvulsive therapy (ECT) is a highly effective treatment for mood disorders. Continuation ECT (C-ECT) and maintenance ECT (M-ECT) are required for many patients suffering from severe and recurrent forms of mood disorders. This is a review of the literature regarding C- and M-ECT. Methods We conducted a computerized search using the words continuation ECT, maintenance ECT, depression, mania, bipolar disorder and mood disorders. We report on all articles published in the English language from 1998 to 2009. Results We identified 32 reports. There were 24 case reports and retrospective reviews on 284 patients. Two of these reports included comparison groups, and 1 had a prospective follow-up in a subset of subjects. There were 6 prospective naturalistic studies and 2 randomized controlled trials. Conclusions C-ECT and M-ECT are valuable treatment modalities to prevent relapse and recurrence of mood disorders in patients who have responded to an index course of ECT. C-ECT and M-ECT are underused and insufficiently studied despite positive clinical experience of more than 70 years. Studies which are currently under way should allow more definitive recommendations regarding the choice, frequency and duration of C-ECT and M-ECT following acute ECT. PMID:21811083

  19. Patient Values and Preferences in Decision Making for Antithrombotic Therapy: A Systematic Review

    PubMed Central

    Mulla, Sohail; Akl, Elie A.; Jankowski, Milosz; Vandvik, Per Olav; Ebrahim, Shanil; McLeod, Shelley; Bhatnagar, Neera; Guyatt, Gordon H.

    2012-01-01

    Background: Development of clinical practice guidelines involves making trade-offs between desirable and undesirable consequences of alternative management strategies. Although the relative value of health states to patients should provide the basis for these trade-offs, few guidelines have systematically summarized the relevant evidence. We conducted a systematic review relating to values and preferences of patients considering antithrombotic therapy. Methods: We included studies examining patient preferences for alternative approaches to antithrombotic prophylaxis and studies that examined, in the context of antithrombotic prophylaxis or treatment, how patients value alternative health states and experiences with treatment. We conducted a systematic search and compiled structured summaries of the results. Steps in the process that involved judgment were conducted in duplicate. Results: We identified 48 eligible studies. Sixteen dealt with atrial fibrillation, five with VTE, four with stroke or myocardial infarction prophylaxis, six with thrombolysis in acute stroke or myocardial infarction, and 17 with burden of antithrombotic treatment. Conclusion: Patient values and preferences regarding thromboprophylaxis treatment appear to be highly variable. Participant responses may depend on their prior experience with the treatments or health outcomes considered as well as on the methods used for preference elicitation. It should be standard for clinical practice guidelines to conduct systematic reviews of patient values and preferences in the specific content area. PMID:22315262

  20. Health-related Quality of Life Assessment after Antiretroviral Therapy: A Review of the Literature

    PubMed Central

    Gakhar, Harleen; Kamali, Amanda

    2015-01-01

    Antiretroviral (ARV) treatment for HIV infection has resulted in significant improvement in immunologic and virologic parameters, as well as a reduction in AIDS-defining illnesses and death. Over 25 medications are approved for use, usually in combination regimens of three or four ARVs. Several ARVs are now available as combinatorial products, which have been associated with better adherence. However, while ARV therapy has prolonged life, ARVs also pose a challenge for quality of life as they can cause significant side effects in addition to the potential for drug toxicity and interaction. Given the many complications, side effects and symptoms of HIV/AIDS in addition to associated medical and psychiatric co-morbidities, the need to understand and assess how these interactions may affect health-related quality of life (HRQOL) has grown. Numerous instruments (some validated, others not) are available and have been applied to understanding how ARV treatment affects HRQOL in those with HIV infection, both in clinical trials and clinical practice. In general, ARV treatment improves HRQOL, but this is dependent on the population being studied, the HRQOL instrument being used and the timeframe during which HRQOL has been studied. This article provides a review of the literature on quality of-life assessment as it relates to ARV treatment in developed countries and briefly reviews the HRQOL instruments used, how they have been applied to ARV utilization, and where future research should be applied in HRQOL assessment and HIV infection. PMID:23591907

  1. Computerized Cognitive Behavior Therapy for Anxiety and Depression in Rural Areas: A Systematic Review

    PubMed Central

    Jones, Martin; Oosterbroek, Chloe

    2015-01-01

    Background People living in rural and remote communities have greater difficulty accessing mental health services and evidence-based therapies, such as cognitive behavior therapy (CBT), than their urban counterparts. Computerized CBT (CCBT) can be used to effectively treat depression and anxiety and may be particularly useful in rural settings where there are a lack of suitably trained practitioners. Objective To systematically review the global evidence regarding the clinical effectiveness and acceptability of CCBT interventions for anxiety and/or depression for people living in rural and remote locations. Methods We searched seven online databases: Medline, Embase Classic and Embase, PsycINFO, CINAHL, Web of Science, Scopus, and the Cochrane Library. We also hand searched reference lists, Internet search engines, and trial protocols. Two stages of selection were undertaken. In the first, the three authors screened citations. Studies were retained if they reported the efficacy, effectiveness or acceptability of CCBT for depression and/or anxiety disorders, were peer reviewed, and written in English. The qualitative data analysis software, NVivo 10, was then used to run automated text searches for the word “rural,” its synonyms, and stemmed words. All studies identified were read in full and were included in the study if they measured or meaningfully discussed the efficacy or acceptability of CCBT among rural participants. Results A total of 2594 studies were identified, of which 11 met the selection criteria and were included in the review. The studies that disaggregated efficacy data by location of participant reported that CCBT was equally effective for rural and urban participants. Rural location was found to both positively and negatively predict adherence across studies. CCBT may be more acceptable among rural than urban participants—studies to date showed that rural participants were less likely to want more face-to-face contact with a practitioner and found that computerized delivery addressed confidentiality concerns. Conclusions CCBT can be effective for addressing depression and anxiety and is acceptable among rural participants. Further work is required to confirm these results across a wider range of countries, and to determine the most feasible model of CCBT delivery, in partnership with people who live and work in rural and remote communities. PMID:26048193

  2. Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Osanai, Toshiya; Pasupuleti, Vinay; Deshpande, Abhishek; Thota, Priyaleela; Roman, Yuani; Hernandez, Adrian V.; Uchino, Ken

    2015-01-01

    Background Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy. PMID:25915905

  3. Extended particle-in-cell schemes for physics in ultrastrong laser fields: Review and developments

    NASA Astrophysics Data System (ADS)

    Gonoskov, A.; Bastrakov, S.; Efimenko, E.; Ilderton, A.; Marklund, M.; Meyerov, I.; Muraviev, A.; Sergeev, A.; Surmin, I.; Wallin, E.

    2015-08-01

    We review common extensions of particle-in-cell (PIC) schemes which account for strong field phenomena in laser-plasma interactions. After describing the physical processes of interest and their numerical implementation, we provide solutions for several associated methodological and algorithmic problems. We propose a modified event generator that precisely models the entire spectrum of incoherent particle emission without any low-energy cutoff, and which imposes close to the weakest possible demands on the numerical time step. Based on this, we also develop an adaptive event generator that subdivides the time step for locally resolving QED events, allowing for efficient simulation of cascades. Further, we present a unified technical interface for including the processes of interest in different PIC implementations. Two PIC codes which support this interface, picador and elmis, are also briefly reviewed.

  4. Extended particle-in-cell schemes for physics in ultrastrong laser fields: Review and developments.

    PubMed

    Gonoskov, A; Bastrakov, S; Efimenko, E; Ilderton, A; Marklund, M; Meyerov, I; Muraviev, A; Sergeev, A; Surmin, I; Wallin, E

    2015-08-01

    We review common extensions of particle-in-cell (PIC) schemes which account for strong field phenomena in laser-plasma interactions. After describing the physical processes of interest and their numerical implementation, we provide solutions for several associated methodological and algorithmic problems. We propose a modified event generator that precisely models the entire spectrum of incoherent particle emission without any low-energy cutoff, and which imposes close to the weakest possible demands on the numerical time step. Based on this, we also develop an adaptive event generator that subdivides the time step for locally resolving QED events, allowing for efficient simulation of cascades. Further, we present a unified technical interface for including the processes of interest in different PIC implementations. Two PIC codes which support this interface, PICADOR and ELMIS, are also briefly reviewed. PMID:26382544

  5. Multisystemic Therapy for Child Non-Externalizing Psychological and Health Problems: A Preliminary Review

    PubMed Central

    White, Rachel S.; Nadorff, Michael R.; Grills-Taquechel, Amie; Stanley, Melinda A.

    2013-01-01

    Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors, specifically difficulties related to child maltreatment, serious psychiatric illness [Serious psychiatric illness was defined throughout the current review paper as the “presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (Level of care placement criteria for psychiatric illness. American Academy of Child and Adolescent Psychiatry, Washington, DC, 1996) level of care placement criteria for psychiatric illness” (Henggeler et al. in J Am Acad Child Psy 38:1331–1345, p. 1332, 1999b). Additionally, youth with “serious emotional disturbance (SED)” defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were “currently in or at imminent risk of a costly out-of-home placement” (Rowland et al. in J Emot Behav Disord 13:13–23, pp. 13–14, 2005) were also included in the serious psychiatric illness category.], and health problems (i.e., obesity and treatment adherence for diabetes). PubMed, Web of Science, MEDLINE, and PsycINFO databases; Clinicaltrials.gov; DARE; Web of Knowledge; and Cochrane Central Register of Controlled Trials were searched; and MST developers were queried to ensure identification of all relevant articles. Of 242 studies identified, 18 met inclusion criteria for review. These were combined in a narrative synthesis and critiqued in the context of review questions. Study quality ratings were all above mean scores reported in prior reviews. Mixed support was found for the efficacy of MST versus other treatments. In many cases, treatment effects for MST or comparison groups were not sustained over time. MST was efficacious for youth with diverse backgrounds. No studies discussed efficacy of MST provided in different treatment settings. Four studies found MST more cost-effective than a comparison treatment, leading to fewer out-of-home placements for youth with serious psychiatric illness or lower treatment costs for youth with poorly controlled diabetes. PMID:23385370

  6. Production of low-Z ions in the Dresden superconducting electron ion beam source for medical particle therapy

    SciTech Connect

    Zschornack, G.; Ritter, E.; Schwan, A.; Ullmann, F.; Grossmann, F.; Ovsyannikov, V. P.

    2012-02-15

    We report on experiments with a new superconducting electron beam ion source (EBIS-SC), the Dresden EBIS-SC, with the objective to meet the main requirements for their application in particle-therapy facilities. Synchrotrons as well as innovative accelerator concepts, such as high-gradient linacs which are driven by a large-current cyclotron (CYCLINACS) and direct drive RF linear accelerators may benefit from the advantages of EBISs in regard to their functional principle. First experimental studies of the production of low-Z ions such as H{sup +}, H{sub 2}{sup +}, H{sub 3}{sup +}, C{sup 4+}, and C{sup 6+} are presented. Particular attention is paid to the ion output, i.e., the number of ions per pulse and per second, respectively. Important beam parameters in this context are, among others, ion pulse shaping, pulse repetition rates, beam emittance, and ion energy spread.

  7. Selective detection of secondary particles and neutrons produced in ion beam therapy with 3D sensitive voxel detector

    NASA Astrophysics Data System (ADS)

    Jakubek, J.; Granja, C.; Hartmann, B.; Jaekel, O.; Martisikova, M.; Opalka, L.; Pospisil, S.

    2011-12-01

    Ion beam therapy is a rapidly developing method for treatment of certain types of cancer. A main advantage of ions is that they deposit most of the energy at the end of their range according to the Bragg curve. Unfortunately, the ion beam often generates a substantial amount of energetic secondary particles with not negligible range. Thus, a fraction of the dose is deposited by other than the primary ions outside of the planned volume. It is, therefore, important to estimate and experimentally verify the distributions of these secondary particles. It is particularly difficult to identify fast neutrons generated by ions in tissue. Fast neutrons are usually detected via their interaction (scattering) with hydrogen nuclei (proton). The proton recoiled by the scattered neutron is subsequently detected by a suitable sensor. The problem is that certain fraction of secondary particles consists of protons as well. Therefore, it is necessary to distinguish protons recoiled by neutrons from protons naturally present in the sample. In this work we present the experimental technique enabling the separation of fast neutrons from protons. The technique uses a 3D sensitive voxel detector composed of several layers of Timepix pixel detectors. These layers are interlaced with a hydrogen rich material (plastic) serving as a convertor of neutrons to recoiled protons. The device records the traces of all interacting radiation providing the time stamp and/or deposited energy for each single particle. A proton passing through the detector creates a trace in all layers, whereas a protons recoiled by neutron originates in the convertor inside of the structure creating a trace in the inner layers only. This way it is possible to distinguish the protons from neutrons with very high selectivity. The technique can be easily extended for detection of slow neutrons. An initial experimental study to register the outcoming neutron radiation was performed at the Heidelberg Ion Beam Therapy Center (HIT) in Germany using medical proton and carbon ion beams. This work is carried out in frame of the Medipix Collaboration.

  8. Monitoring of patients treated with particle therapy using positron-emission-tomography (PET): the MIRANDA study

    PubMed Central

    2012-01-01

    Background The purpose of this clinical study is to investigate the clinical feasibility and effectiveness of offline Positron-Emission-Tomography (PET) quality assurance for promoting the accuracy of proton and carbon ion beam therapy. Methods/Design A total of 240 patients will be recruited, evenly sampled among different analysis groups including tumors of the brain, skull base, head and neck region, upper gastrointestinal tract including the liver, lower gastrointestinal tract, prostate and pelvic region. From the comparison of the measured activity with the planned dose and its corresponding simulated activity distribution, conclusions on the delivered treatment will be inferred and, in case of significant deviations, correction strategies will be elaborated. Discussion The investigated patients are expected to benefit from this study, since in case of detected deviations between planned and actual treatment delivery a proper intervention (e.g., correction) could be performed in a subsequent irradiation fraction. In this way, an overall better treatment could be achieved than without any in-vivo verification. Moreover, site-specific patient-population information on the precision of the ion range at HIT might enable improvement of the CT-range calibration curve as well as safe reduction of the treatment margins to promote enhanced treatment plan conformality and dose escalation for full clinical exploitation of the promises of ion beam therapy. Trial Registration NCT01528670 PMID:22471947

  9. Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases

    PubMed Central

    Karmacharya, Paras; Pathak, Ranjan; Ghimire, Sailu; Shrestha, Pragya; Ghimire, Sushil; Poudel, Dilli Ram; Khanal, Raju; Shah, Shirin; Aryal, Madan Raj; Alweis, Richard L

    2015-01-01

    Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases. PMID:26713297

  10. Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases.

    PubMed

    Karmacharya, Paras; Pathak, Ranjan; Ghimire, Sailu; Shrestha, Pragya; Ghimire, Sushil; Poudel, Dilli Ram; Khanal, Raju; Shah, Shirin; Aryal, Madan Raj; Alweis, Richard L

    2015-11-01

    Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases. PMID:26713297

  11. The effectiveness of extracorporeal shock wave therapy for the treatment of lower limb ulceration: a systematic review.

    PubMed

    Butterworth, Paul A; Walsh, Tom P; Pennisi, Yvonne D; Chesne, Anna D; Schmitz, Christoph; Nancarrow, Susan A

    2015-01-01

    Extracorporeal shock wave therapy has been reported as an effective treatment for lower limb ulceration. The aim of this systematic review was to investigate the effectiveness of extracorporeal shock wave therapy for the treatment of lower limb ulceration. Five electronic databases (Ovid MEDLINE, CINAHL, Web of Knowledge, Scopus and Ovid AMED) and reference lists from relevant studies were searched in December 2013. All study designs, with the exception of case-reports, were eligible for inclusion in this review. Assessment of each study's methodological quality was performed using the Quality Index tool. The effectiveness of studies was measured by calculating effect sizes (Cohen's d) from means and standard deviations. Five studies, including; three randomised controlled trials, one quasi-experimental study and one case-series design met our inclusion criteria and were reviewed. Quality assessment scores ranged from 38 to 63% (mean 53%). Improvements in wound healing were identified in these studies following extracorporeal shock wave therapy. The majority of wounds assessed were associated with diabetes and the effectiveness of ESWT as an addition to standard care has only been assessed in one randomised controlled trial. Considering the limited evidence identified, further research is needed to support the use of extracorporeal shock wave therapy in the treatment of lower limb ulceration. PMID:25722746

  12. Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-Analysis

    PubMed Central

    Lambert, Allison A.; Lam, Jennifer O.; Paik, Julie J.; Ugarte-Gil, Cesar; Drummond, M. Bradley; Crowell, Trevor A.

    2015-01-01

    Background Proton-pump inhibitors (PPIs) are among the most frequently prescribed medications. Community-acquired pneumonia (CAP) is a common cause of morbidity, mortality and healthcare spending. Some studies suggest an increased risk of CAP among PPI users. We conducted a systematic review and meta-analysis to determine the association between outpatient PPI therapy and risk of CAP in adults. Methods We conducted systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Scopus and Web of Science on February 3, 2014. Case-control studies, case-crossover, cohort studies and randomized controlled trials reporting outpatient PPI exposure and CAP diagnosis for patients ?18 years old were eligible. Our primary outcome was the association between CAP and PPI therapy. A secondary outcome examined the risk of hospitalization for CAP and subgroup analyses evaluated the association between PPI use and CAP among patients of different age groups, by different PPI doses, and by different durations of PPI therapy. Results Systematic review of 33 studies was performed, of which 26 studies were included in the meta-analysis. These 26 studies included 226,769 cases of CAP among 6,351,656 participants. We observed a pooled risk of CAP with ambulatory PPI therapy of 1.49 (95% CI 1.16, 1.92; I2 99.2%). This risk was increased during the first month of therapy (OR 2.10; 95% CI 1.39, 3.16), regardless of PPI dose or patient age. PPI therapy also increased risk for hospitalization for CAP (OR 1.61; 95% CI: 1.12, 2.31). Discussion Outpatient PPI use is associated with a 1.5-fold increased risk of CAP, with the highest risk within the first 30 days after initiation of therapy. Providers should be aware of this risk when considering PPI use, especially in cases where alternative regimens may be available or the benefits of PPI use are uncertain. PMID:26042842

  13. Chinese Medicine in Inhalation Therapy: A Review of Clinical Application and Formulation Development.

    PubMed

    Miao, Xiaoqing; Zhou, Jing; Li, Jian; Liao, Yonghong; Zheng, Ying

    2015-01-01

    Chinese medicine (CM) in inhalation therapy has a long history of applications since ancient China in the forms of smoke, steam vapor, medicated pillows and aromatic sachets. Over the years, thousands of clinical treatments involving the inhalation of CMs have been reported for the treatment of respiratory disease. Shuanghuanglian, Yuxingcao and Qingkailing are primarily applied in pneumonia and bronchitis. At present, metered dose inhalation (MDI), aromatic inhalation and nebulized inhalation are used extensively in practice. In particular, nebulized CM for the treatment of respiratory diseases has been applied as a noninvasive route with reduced serious adverse reactions and is equivalent to or more efficacious than its intravenous counterparts. Although nebulized CM is widely used in clinical practice, only three MDI and five aromatic inhalations of CM products have been approved by the China Food and Drug Administration (CFDA), and no products in the form of a dry powder inhaler (DPI) or in dosage forms intended for nebulization have been reported. The development of formulations for CM has focused on improving the aerodynamic performance of the particles prepared by spray drying, enhancing the bioavailability and local concentration in the respiratory tract, and increasing the mucoadhesion and sustained release of the CM upon the incorporation of novel excipients. New devices, including MDI and nebulizer devices, have been developed for the delivery of the above-mentioned particles to the pulmonary system. Although the development of CM inhalation products to meet the international quality standards is facing a number of challenges, the inhalation of CMs show great potential for further exploration, particularly as an alternative route to IV infusion for the treatment of respiratory diseases. PMID:26290197

  14. Radiation therapy for cutaneous blastic plasmacytoid dendritic cell neoplasm: a case report and review of the literature

    PubMed Central

    Ishibashi, Naoya; Maebayashi, Toshiya; Aizawa, Takuya; Sakaguchi, Masakuni; Abe, Osamu; Miura, Katsuhiro; Hatta, Yoshihiro; Sugitani, Masahiko

    2015-01-01

    Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare tumor that usually arises in the skin. Most patients develop skin lesions, which may be isolated and subsequently spread to affect the whole body. The prognosis is poor. Although BPDCN is usually treated by chemotherapy, radiation therapy is used in some cases (e.g., isolated lesions, elderly patients, or patients with comorbidities). The overall therapeutic efficacy and dose of radiation therapy remain unknown. We herein present a case of successful radiation treatment for BPDCN in a 77-year-old Japanese patient and describe the results of the first literature review on BPDCN of the skin initially treated with radiation therapy. The patient developed a raised, tender, pruritic skin lesion on his left forearm and similar multiple disseminated lesions on his right shoulder and precordial region. Histological and immunohistochemical examination of biopsy specimens of the skin lesions on the left forearm and right shoulder established a diagnosis of BPDCN. The other multiple skin lesions were considered to be disseminated BPDCN. The patient declined chemotherapy and instead elected radiation therapy for the lesion on his left forearm (total of 30 Gy). The skin lesion regressed until only pigmentation was present on the forearm, but the untreated lesions rapidly expanded. Although BPDCN of the skin may respond favorably to initial radiation therapy, it tends to recur in the short term. The optimal dose of radiation therapy remains unclear. Our findings provide a baseline for future research. PMID:26221394

  15. Beyond statin therapy: a review of the management of residual risk in diabetes mellitus

    PubMed Central

    Judge, Eoin P; Phelan, D; O'Shea, Donal

    2010-01-01

    Summary Total cholesterol and low-density lipoprotein (LDL) cholesterol exhibit an independent, strong, continuous correlation with cardiovascular events. The effectiveness of hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) in the treatment and prevention of atherosclerosis is well-established. However, despite the lowering of LDL targets and the increased use of statins, patients with type 2 diabetes mellitus (DM) continue to experience a higher proportion of adverse coronary artery disease events. This is as a result of an atherogenic dyslipidaemia, characterized by low levels of high-density lipoprotein and elevated plasma triglyceride concentrations, often with high levels of cholesterol-rich remnant particles. This article will review dyslipidaemia and its role in DM, and will discuss available treatment modalities that address residual cardiovascular risk in this disease. PMID:20807991

  16. Promotional Tone in Reviews of Menopausal Hormone Therapy After the Women's Health Initiative: An Analysis of Published Articles

    PubMed Central

    Fugh-Berman, Adriane; McDonald, Christina Pike; Bell, Alicia M.; Bethards, Emily Catherine; Scialli, Anthony R.

    2011-01-01

    Background Even after the Women's Health Initiative (WHI) found that the risks of menopausal hormone therapy (hormone therapy) outweighed benefit for asymptomatic women, about half of gynecologists in the United States continued to believe that hormones benefited women's health. The pharmaceutical industry has supported publication of articles in medical journals for marketing purposes. It is unknown whether author relationships with industry affect promotional tone in articles on hormone therapy. The goal of this study was to determine whether promotional tone could be identified in narrative review articles regarding menopausal hormone therapy and whether articles identified as promotional were more likely to have been authored by those with conflicts of interest with manufacturers of menopausal hormone therapy. Methods and Findings We analyzed tone in opinion pieces on hormone therapy published in the four years after the estrogen-progestin arm of the WHI was stopped. First, we identified the ten authors with four or more MEDLINE-indexed reviews, editorials, comments, or letters on hormone replacement therapy or menopausal hormone therapy published between July 2002 and June 2006. Next, we conducted an additional search using the names of these authors to identify other relevant articles. Finally, after author names and affiliations were removed, 50 articles were evaluated by three readers for scientific accuracy and for tone. Scientific accuracy was assessed based on whether or not the findings of the WHI were accurately reported using two criteria: (1) Acknowledgment or lack of denial of the risk of breast cancer diagnosis associated with hormone therapy, and (2) acknowledgment that hormone therapy did not benefit cardiovascular disease endpoints. Determination of promotional tone was based on the assessment by each reader of whether the article appeared to promote hormone therapy. Analysis of inter-rater consistency found moderate agreement for scientific accuracy (??=?0.57) and substantial agreement for promotional tone (??=?0.65). After discussion, readers found 86% of the articles to be scientifically accurate and 64% to be promotional in tone. Themes that were common in articles considered promotional included attacks on the methodology of the WHI, arguments that clinical trial results should not guide treatment for individuals, and arguments that observational studies are as good as or better than randomized clinical trials for guiding clinical decisions. The promotional articles we identified also implied that the risks associated with hormone therapy have been exaggerated and that the benefits of hormone therapy have been or will be proven. Of the ten authors studied, eight were found to have declared payment for speaking or consulting on behalf of menopausal hormone manufacturers or for research support (seven of these eight were speakers or consultants). Thirty of 32 articles (90%) evaluated as promoting hormone therapy were authored by those with potential financial conflicts of interest, compared to 11 of 18 articles (61%) by those without such conflicts (p?=?0.0025). Articles promoting the use of menopausal hormone therapy were 2.41 times (95% confidence interval 1.49–4.93) as likely to have been authored by authors with conflicts of interest as by authors without conflicts of interest. In articles from three authors with conflicts of interest some of the same text was repeated word-for-word in different articles. Conclusion There may be a connection between receiving industry funding for speaking, consulting, or research and the publication of promotional opinion pieces on menopausal hormone therapy. Please see later in the article for the Editors' Summary PMID:21423581

  17. Is manipulative therapy more effective than sham manipulation in adults?: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Manipulative therapy is widely used in the treatment of spinal disorders. Manipulative techniques are under debate because of the possibility of adverse events. To date, the efficacy of manipulations compared to sham manipulations is unclear. The purpose of the study is: to assess the efficacy of manipulative therapy compared to sham in adults with a variety of complaints. Study design Systematic review and meta-analysis. Methods Bibliographic databases (PubMed, EMBASE, CINAHL, PEDro, Central) along with a hand search of selected bibliographies were searched from inception up to April 2012. Two reviewers independently selected randomized clinical trials (RCTs) that evaluated manipulative therapy compared to sham manipulative therapy in adults, assessed risk of bias and extracted data concerning participants, intervention, kind of sham, outcome measures, duration of follow-up, profession, data on efficacy and adverse events. Pooled (standardized) mean differences or risk differences were calculated were possible using a random effects model. The primary outcomes were pain, disability, and perceived recovery. The overall quality of the body of evidence was evaluated using GRADE. Results In total 965 references were screened for eligibility and 19 RCTs (n?=?1080) met the selection criteria. Eight studies were considered of low risk of bias. There is moderate level of evidence that manipulative therapy has a significant effect in adults on pain relief immediately after treatment (standardized mean difference [SMD] - 0.68, 95% confidence interval (-1.06 to -0.31). There is low level of evidence that manipulative therapy has a significant effect in adults on pain relief (SMD - 0.37, -0.69 to -0.04) at short- term follow-up. In patients with musculoskeletal disorders, we found moderate level of evidence for pain relief (SMD - 0.73, -1.21 to -0.25) immediate after treatment and low level of evidence for pain relief (SMD - 0.52, -0.87 to -0.17) at short term-follow-up. We found very low level of evidence that manipulative therapy has no statistically significant effect on disability and perceived (asthma) recovery. Sensitivity analyses did not change the main findings. No serious adverse events were reported in the manipulative therapy or sham group. Conclusions Manipulative therapy has a clinical relevant effect on pain, but not on disability or perceived (asthma) recovery. Clinicians can refer patients for manipulative therapy to reduce pain. PMID:24274314

  18. Preparation by alkaline treatment and detailed characterisation of empty hepatitis B virus core particles for vaccine and gene therapy applications

    NASA Astrophysics Data System (ADS)

    Strods, Arnis; Ose, Velta; Bogans, Janis; Cielens, Indulis; Kalnins, Gints; Radovica, Ilze; Kazaks, Andris; Pumpens, Paul; Renhofa, Regina

    2015-06-01

    Hepatitis B virus (HBV) core (HBc) virus-like particles (VLPs) are one of the most powerful protein engineering tools utilised to expose immunological epitopes and/or cell-targeting signals and for the packaging of genetic material and immune stimulatory sequences. Although HBc VLPs and their numerous derivatives are produced in highly efficient bacterial and yeast expression systems, the existing purification and packaging protocols are not sufficiently optimised and standardised. Here, a simple alkaline treatment method was employed for the complete removal of internal RNA from bacteria- and yeast-produced HBc VLPs and for the conversion of these VLPs into empty particles, without any damage to the VLP structure. The empty HBc VLPs were able to effectively package the added DNA and RNA sequences. Furthermore, the alkaline hydrolysis technology appeared efficient for the purification and packaging of four different HBc variants carrying lysine residues on the HBc VLP spikes. Utilising the introduced lysine residues and the intrinsic aspartic and glutamic acid residues exposed on the tips of the HBc spikes for chemical coupling of the chosen peptide and/or nucleic acid sequences ensured a standard and easy protocol for the further development of versatile HBc VLP-based vaccine and gene therapy applications.

  19. Preparation by alkaline treatment and detailed characterisation of empty hepatitis B virus core particles for vaccine and gene therapy applications

    PubMed Central

    Strods, Arnis; Ose, Velta; Bogans, Janis; Cielens, Indulis; Kalnins, Gints; Radovica, Ilze; Kazaks, Andris; Pumpens, Paul; Renhofa, Regina

    2015-01-01

    Hepatitis B virus (HBV) core (HBc) virus-like particles (VLPs) are one of the most powerful protein engineering tools utilised to expose immunological epitopes and/or cell-targeting signals and for the packaging of genetic material and immune stimulatory sequences. Although HBc VLPs and their numerous derivatives are produced in highly efficient bacterial and yeast expression systems, the existing purification and packaging protocols are not sufficiently optimised and standardised. Here, a simple alkaline treatment method was employed for the complete removal of internal RNA from bacteria- and yeast-produced HBc VLPs and for the conversion of these VLPs into empty particles, without any damage to the VLP structure. The empty HBc VLPs were able to effectively package the added DNA and RNA sequences. Furthermore, the alkaline hydrolysis technology appeared efficient for the purification and packaging of four different HBc variants carrying lysine residues on the HBc VLP spikes. Utilising the introduced lysine residues and the intrinsic aspartic and glutamic acid residues exposed on the tips of the HBc spikes for chemical coupling of the chosen peptide and/or nucleic acid sequences ensured a standard and easy protocol for the further development of versatile HBc VLP-based vaccine and gene therapy applications. PMID:26113394

  20. State of the Art on the Evidence Base in Cardiac Regenerative Therapy: Overview of 41 Systematic Reviews

    PubMed Central

    Peruzzi, Mariangela; De Falco, Elena; Abbate, Antonio; Biondi-Zoccai, Giuseppe; Chimenti, Isotta; Lotrionte, Marzia; Benedetto, Umberto; Delewi, Ronak; Marullo, Antonino G. M.; Frati, Giacomo

    2015-01-01

    Objectives. To provide a comprehensive appraisal of the evidence from secondary research on cardiac regenerative therapy. Study Design and Setting. Overview of systematic reviews of controlled clinical trials concerning stem cell administration or mobilization in patients with cardiovascular disease. Results. After a systematic database search, we short-listed 41 reviews (660 patients). Twenty-two (54%) reviews focused on acute myocardial infarction (AMI), 19 (46%) on chronic ischemic heart disease (IHD) or heart failure (HF), 29 (71%) on bone marrow-derived stem-cells (BMSC), and 36 (88%) to randomized trials only. Substantial variability among reviews was found for validity (AMSTAR score: median 9 [minimum 3]; 1st quartile 9; 3rd quartile 10; maximum 11), effect estimates (change in ejection fraction from baseline to follow-up: 3.47% [0.02%; 2.90%; 4.22%; 6.11%]), and citations (Web of Science yearly citations: 4.1 [0; 2.2; 6.5; 68.9]). No significant association was found between these three features. However, reviews focusing on BMSC therapy had higher validity scores (P = 0.008) and showed more pronounced effect estimates (P = 0.002). Higher citations were associated with journal impact factor (P = 0.007), corresponding author from North America/Europe (P = 0.022), and inclusion of nonrandomized trials (P = 0.046). Conclusions. Substantial heterogeneity is apparent among these reviews in terms of quality and effect estimates. PMID:26176013

  1. Physical therapy after spinal cord injury: A systematic review of treatments focused on participation

    PubMed Central

    Gómara-Toldrà, Natàlia; Sliwinski, Martha; Dijkers, Marcel P.

    2014-01-01

    Context Over the last four decades, the focus of spinal cord injury (SCI) rehabilitation has shifted from medical management to issues that affect quality of life and community participation. Physical therapists (PTs) need to design and implement interventions that result in maximal participation to provide an individual with SCI an effective rehabilitation program. Objective The aim of this review is to assess the extent, content, and outcomes of physical therapy (PT) interventions focused on improving the participation of individuals with SCI. Methods A search was conducted in Medline, Embase, CENTRAL, CINAHL, PEDro, and PsycINFO. We included studies, of all designs, focused on improving the participation of individuals with SCI using PT interventions.The primary author and a reviewer independently selected articles for inclusion, assessed articles quality, and extracted the data. Results Five studies met the inclusion criteria. The interventions applied were 9- and 12-month body weight-supported treadmill training in two studies, a supervised 9-month exercise program, a 12-week home exercise program, and a 10-week multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain. Four of five PT interventions positively impacted the individual's perceived participation and satisfaction with participation. Conclusion The body of research by PTs on interventions to improve participation is limited. PTs must document the effects of interventions with a valid outcome tool to enable more research that examines participation. Expanding participation research will allow PTs to meet the needs of individuals with SCI and identify what interventions best facilitate integration into the community. PMID:24621042

  2. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients

    PubMed Central

    Garland, Sheila N; Johnson, Jillian A; Savard, Josee; Gehrman, Philip; Perlis, Michael; Carlson, Linda; Campbell, Tavis

    2014-01-01

    Individuals with cancer are disproportionately affected by sleep disturbance and insomnia relative to the general population. These problems can be a consequence of the psychological, behavioral, and physical effects of a cancer diagnosis and treatment. Insomnia often persists for years and, when combined with already high levels of cancer-related distress, may place cancer survivors at a higher risk of future physical and mental health problems and poorer quality of life. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), a non-pharmacological treatment that incorporates cognitive and behavior-change techniques and targets dysfunctional attitudes, beliefs, and habits involving sleep. This article presents a comprehensive review of the literature examining the efficacy of CBT-I on sleep and psychological outcomes in cancer patients and survivors. The search revealed 12 studies (four uncontrolled, eight controlled) that evaluated the effects of CBT-I in cancer patients or survivors. Results suggest that CBT-I is associated with statistically and clinically significant improvements in subjective sleep outcomes in patients with cancer. CBT-I may also improve mood, fatigue, and overall quality of life, and can be successfully delivered through a variety of treatment modalities, making it possible to reach a broader range of patients who may not have access to more traditional programs. Future research in this area should focus on the translation of evidence into clinical practice in order to increase awareness and access to effective insomnia treatment in cancer care. PMID:24971014

  3. A review of mechanisms of response to pain therapy: why voodoo works.

    PubMed

    Solomon, Seymour

    2002-01-01

    A person's response to pain treatment may be due to factors other than the direct effect of analgesics. Amelioration of pain is often associated with modalities that appear to make no scientific sense. This review outlines the mechanisms of pain amelioration other than that by medication. These mechanisms help to explain why pain relief may follow the administration of allopathic modalities. Pain is modulated, enhanced, or diminished by both cerebral and peripheral mechanisms. Cerebral factors include the placebo response, psychological phenomena, and conscious cognitive activation. In addition to evoking endogenous opioids, these central mechanisms activate antinociceptive pathways beginning in the limbic forebrain and relayed in the periaqueductal gray matter to primary afferent nociceptive sites in the spinal cord dorsal horn (and medullary nucleus caudalis). Obvious peripheral factors that may diminish pain perception are those that decrease afferent stimuli. Paradoxically, stimulation of afferent neurons may also ameliorate pain by activating spinal or supraspinal inhibitory mechanisms. Finally, improvement in pain or other symptoms is often falsely attributed to a therapy when remission occurs because the underlying illness has run its normal course. PMID:12482220

  4. Low Level Laser Therapy (LLLT) for Neck Pain: A Systematic Review and Meta-Regression

    PubMed Central

    Gross, Anita R; Dziengo, Stephanie; Boers, Olga; Goldsmith, Charlie H; Graham, Nadine; Lilge, Lothar; Burnie, Stephen; White, Roger

    2013-01-01

    Purpose: This systematic review update evaluated low level laser therapy (LLLT) for adults with neck pain. Methods: Computerized searches (root up to Feb 2012) included pain, function/disability, quality of life (QoL) and global perceived effect (GPE). GRADE, effect-sizes, heterogeneity and meta-regression were assessed. Results: Of 17 trials, 10 demonstrated high risk of bias. For chronic neck pain, there was moderate quality evidence (2 trials, 109 participants) supporting LLLT over placebo to improve pain/disability/QoL/GPE up to intermediate-term (IT). For acute radiculopathy, cervical osteoarthritis or acute neck pain, low quality evidence suggested LLLT improves ST pain/function/QoL over a placebo. For chronic myofascial neck pain (5 trials, 188 participants), evidence was conflicting; a meta-regression of heterogeneous trials suggests super-pulsed LLLT increases the chance of a successful pain outcome. Conclusions: We found diverse evidence using LLLT for neck pain. LLLT may be beneficial for chronic neck pain/function/QoL. Larger long-term dosage trials are needed. PMID:24155802

  5. Low-Level Laser Therapy in the Treatment of Recurrent Aphthous Ulcers: A Systematic Review

    PubMed Central

    Vale, Fernando Alves; de Almeida, Fernanda Campos Souza

    2015-01-01

    Recurrent aphthous ulcers (RAUs) are the most common lesion found in the oral cavity. There is no definitive cure for RAUs and current treatments are aimed at minimizing symptoms. Since low-level laser therapy (LLLT) modulates inflammatory responses, and promotes pain reduction and cellular biostimulation, LLLT can be suggested as an alternative treatment for RAUs. The literature concerning the potential of LLLT in the treatment of RAUs was evaluated. A systematic literature review identified 22 publications, of which only 2 studies were adopted. The eligibility criteria consisted of randomized controlled trials (RCTs). Both RCTs achieved significant results concerning LLLT and pain-level reductions and reduced healing times. Despite the variance in irradiation conditions applied in both studies, very similar wavelengths were adopted. There is accordingly strong evidence that wavelength plays an important role in RAU treatment. Taking into account the different parameters applied by selected RCTs, it is not possible to suggest that a specific protocol should be used. However, in light of the significant results found in both studies, LLLT can be suggested as an alternative for RAU treatment. Additional RCTs should be performed in order to reach a clinical protocol and better understand the application of LLLT in RAU treatment. PMID:25879049

  6. Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria.

    PubMed

    Leichsenring, Falk; Luyten, Patrick; Hilsenroth, Mark J; Abbass, Allan; Barber, Jacques P; Keefe, John R; Leweke, Frank; Rabung, Sven; Steinert, Christiane

    2015-07-01

    Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive-supportive continuum and is frequently used in clinical practice. The use of any form of psychotherapy should be supported by sufficient evidence. Efficacy research has been neglected in PDT for a long time. In this review, we describe methodological requirements for proofs of efficacy and summarise the evidence for use of PDT to treat mental health disorders. After specifying the requirements for superiority, non-inferiority, and equivalence trials, we did a systematic search using the following criteria: randomised controlled trial of PDT; use of treatment manuals or manual-like guidelines; use of reliable and valid measures for diagnosis and outcome; adults treated for specific mental problems. We identified 64 randomised controlled trials that provide evidence for the efficacy of PDT in common mental health disorders. Studies sufficiently powered to test for equivalence to established treatments did not find substantial differences in efficacy. These results were corroborated by several meta-analyses that suggest PDT is as efficacious as treatments established in efficacy. More randomised controlled trials are needed for some mental health disorders such as obsessive-compulsive disorder and post-traumatic stress disorder. Furthermore, more adequately powered equivalence trials are needed. PMID:26303562

  7. Does low-level laser therapy have an antianesthetic effect? A review.

    PubMed

    Aras, Mutan Hamdi; Omezli, Mehmet Melih; Güngörmü?, Metin

    2010-12-01

    Because local anesthetics are vasodilators, they tend to be absorbed into the bloodstream from the operative field as a result of the vasodilation of peripheral arterioles. To counteract this vasodilation, vasoconstrictive agents are often included in local anesthetic solutions to provide a longer duration of anesthesia. Low-level laser therapy (LLLT) has the same benefits, such as microcirculation activation and more-efficient tissue metabolism, analgesic effects, and vasodilatation. If LLLT is used to prevent pain postoperatively, improvements in local circulation and increased vasodilatation may increase the absorption of a local anesthetic agent. This may reduce the duration of the anesthesia, thereby allowing postoperative pain management to begin sooner. The maximal intensity of pain occurs during the first hours after surgery, when the local anesthetic has worn off. Theoretically, postoperative pain control can be increased with the use of a local anesthetic with a more-prolonged action. If a treatment method has both analgesic and antianesthetic effects, then the method may block its own effects. We review whether LLLT applied postoperatively to operated-on areas has an antianesthetic effect, that is, whether pain in the first hours after surgery was greater for patients who received LLLT than for control patients. Not too much evidence supports the antianesthetic effects of LLLT. However, additional experimental and clinical studies must be performed to investigate the effects of LLLT on the duration of anesthesia. PMID:20973738

  8. Stereotactic body radiation therapy for abdominal oligometastases: a biological and clinical review

    PubMed Central

    2012-01-01

    Advances in imaging and biological targeting have led to the development of stereotactic body radiation therapy (SBRT) as an alternative treatment of extracranial oligometastases. New radiobiological concepts, such as ceramide-induced endothelial apoptosis after hypofractionated high-dose SBRT, and the identification of patients with oligometastatic disease by microRNA expression may yet lead to further developments. Key factors in SBRT are delivery of a high dose per fraction, proper patient positioning, target localisation, and management of breathing–related motion. Our review addresses the radiation doses and schedules used to treat liver, abdominal lymph node (LN) and adrenal gland oligometastases and treatment outcomes. Reported local control (LC) rates for liver and abdominal LN oligometastases are high (median 2-year actuarial LC: 61 -100% for liver oligometastases; 4-year actuarial LC: 68% in a study of abdominal LN oligometastases). Early toxicity is low-to-moderate; late adverse effects are rare. SBRT of adrenal gland oligometastases shows promising results in the case of isolated lesions. In conclusion, properly conducted SBRT procedures are a safe and effective treatment option for abdominal oligometastases. PMID:22852764

  9. Contrast Water Therapy and Exercise Induced Muscle Damage: A Systematic Review and Meta-Analysis

    PubMed Central

    Bieuzen, François; Bleakley, Chris M.; Costello, Joseph Thomas

    2013-01-01

    The aim of this systematic review was to examine the effect of Contrast Water Therapy (CWT) on recovery following exercise induced muscle damage. Controlled trials were identified from computerized literature searching and citation tracking performed up to February 2013. Eighteen trials met the inclusion criteria; all had a high risk of bias. Pooled data from 13 studies showed that CWT resulted in significantly greater improvements in muscle soreness at the five follow-up time points (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Pooled data also showed that CWT significantly reduced muscle strength loss at each follow-up time (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Despite comparing CWT to a large number of other recovery interventions, including cold water immersion, warm water immersion, compression, active recovery and stretching, there was little evidence for a superior treatment intervention. The current evidence base shows that CWT is superior to using passive recovery or rest after exercise; the magnitudes of these effects may be most relevant to an elite sporting population. There seems to be little difference in recovery outcome between CWT and other popular recovery interventions. PMID:23626806

  10. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

    PubMed Central

    Rossen, Noortje G; MacDonald, John K; de Vries, Elisabeth M; D'Haens, Geert R; de Vos, Willem M; Zoetendal, Erwin G; Ponsioen, Cyriel Y

    2015-01-01

    AIM: To study the clinical efficacy and safety of Fecal microbiota transplantation (FMT). We systematically reviewed FMT used as clinical therapy. METHODS: We searched MEDLINE, EMBASE, the Cochrane Library and Conference proceedings from inception to July, 2013. Treatment effect of FMT was calculated as the percentage of patients who achieved clinical improvement per patient category, on an intention-to-treat basis. RESULTS: We included 45 studies; 34 on Clostridium difficile-infection (CDI), 7 on inflammatory bowel disease, 1 on metabolic syndrome, 1 on constipation, 1 on pouchitis and 1 on irritable bowel syndrome (IBS). In CDI 90% resolution of diarrhea in 33 case series (n = 867) was reported, and 94% resolution of diarrhea after repeated FMT in a randomized controlled trial (RCT) (n = 16). In ulcerative colitis (UC) remission rates of 0% to 68% were found (n = 106). In Crohn’s disease (CD) (n = 6), no benefit was observed. In IBS, 70% improvement of symptoms was found (n = 13). 100% Reversal of symptoms was observed in constipation (n = 3). In pouchitis, none of the patients (n = 8) achieved remission. One RCT showed significant improvement of insulin sensitivity in metabolic syndrome (n = 10). Serious adverse events were rare. CONCLUSION: FMT is highly effective in CDI, and holds promise in UC. As for CD, chronic constipation, pouchitis and IBS data are too limited to draw conclusions. FMT increases insulin sensitivity in metabolic syndrome. PMID:25954111

  11. TOPICAL REVIEW: Biological imaging in radiation therapy: role of positron emission tomography

    NASA Astrophysics Data System (ADS)

    Nestle, Ursula; Weber, Wolfgang; Hentschel, Michael; Grosu, Anca-Ligia

    2009-01-01

    In radiation therapy (RT), staging, treatment planning, monitoring and evaluation of response are traditionally based on computed tomography (CT) and magnetic resonance imaging (MRI). These radiological investigations have the significant advantage to show the anatomy with a high resolution, being also called anatomical imaging. In recent years, so called biological imaging methods which visualize metabolic pathways have been developed. These methods offer complementary imaging of various aspects of tumour biology. To date, the most prominent biological imaging system in use is positron emission tomography (PET), whose diagnostic properties have clinically been evaluated for years. The aim of this review is to discuss the valences and implications of PET in RT. We will focus our evaluation on the following topics: the role of biological imaging for tumour tissue detection/delineation of the gross tumour volume (GTV) and for the visualization of heterogeneous tumour biology. We will discuss the role of fluorodeoxyglucose-PET in lung and head and neck cancer and the impact of amino acids (AA)-PET in target volume delineation of brain gliomas. Furthermore, we summarize the data of the literature about tumour hypoxia and proliferation visualized by PET. We conclude that, regarding treatment planning in radiotherapy, PET offers advantages in terms of tumour delineation and the description of biological processes. However, to define the real impact of biological imaging on clinical outcome after radiotherapy, further experimental, clinical and cost/benefit analyses are required.

  12. A Comprehensive Review of Head and Neck Cancer Rehabilitation: Physical Therapy Perspectives

    PubMed Central

    Guru, Karthikeyan; Manoor, Udaya Kumar; Supe, Sanjay Sudhakar

    2012-01-01

    Rehabilitation in relation to cancer can be preventative, restorative, supportive, and palliative. It is recognized that patients may have rehabilitation needs throughout their care pathway. The role of physiotherapy in the cancer rehabilitation is less understood and particularly in the head and neck cancer (HNC) patients. This results in various residual deformities and dysfunctions for the patients with HNC. The objective of this review is to provide detailed information regarding the problems faced after the cancer treatments and rehabilitation of patients who suffered with HNC. The fact that cancer patients are facing several months of chemotherapy and/or radiotherapy and usually major surgery, as well as the direct effect of immobility due to pain, means that muscle wasting, joint stiffness, as well as de-conditioning and fatigue are inevitable. The absence of physiotherapy intervention would be detrimental to patient care and the ability of the patient/family to cope with the effects of the disease or its treatment on their functional capacity and quality of life. Following any treatment for HNC, physical therapy may play an essential role in preventing various complications and helping patients to mitigate impairments, and restoring function of the shoulder joint, neck, and face. PMID:23093823

  13. Effects of low-level laser therapy on skeletal muscle repair: a systematic review.

    PubMed

    Alves, Agnelo Neves; Fernandes, Kristianne Porta Santos; Deana, Alessandro Melo; Bussadori, Sandra Kalil; Mesquita-Ferrari, Raquel Agnelli

    2014-12-01

    A review of the literature was performed to demonstrate the most current applicability of low-level laser therapy (LLLT) for the treatment of skeletal muscle injuries, addressing different lasers, irradiation parameters, and treatment results in animal models. Searches were performed in the PubMed/MEDLINE, SCOPUS, and SPIE Digital Library databases for studies published from January 2006 to August 2013 on the use of LLLT for the repair of skeletal muscle in any animal model. All selected articles were critically appraised by two independent raters. Seventeen of the 36 original articles on LLLT and muscle injuries met the inclusion criteria and were critically evaluated. The main effects of LLLT were a reduction in the inflammatory process, the modulation of growth factors and myogenic regulatory factors, and increased angiogenesis. The studies analyzed demonstrate the positive effects of LLLT on the muscle repair process, which are dependent on irradiation and treatment parameters. The findings suggest that LLLT is an excellent therapeutic resource for the treatment of skeletal muscle injuries in the short-term. PMID:25122099

  14. Stem cell-based therapy for treating limbal stem cells deficiency: A review of different strategies

    PubMed Central

    He, Hong; Yiu, Samuel C.

    2014-01-01

    The self renewal capability of limbal epithelial stem (LEST) cells is fundamental to the maintenance and healing of corneal epithelium. Limbal stem cell deficiency (LSCD), due to dysfunction or loss of LEST cells, therefore presents as persistent epithelial defects, corneal vascularization, conjunctivalization etc. Stem cell-based therapy, in its simplest form – limbal autograft, has been used successfully for more than a decade. For bilateral LSCD, similar approaches with limbal allografts have been unsuccessful largely due to strong immune rejection. Therefore, as an alternate strategy for treating bilateral LSCD, ex vivo expansion of the remaining LEST cells or autologous stem cells sourced from other potential sites is being explored. Different culture systems (with and without xenobiotic supplements) using substrates like amniotic membrane or fibrin gels have been used successfully for ex vivo LEST cell maintenance and reproduction by imitating the stem cell niche. This paper is organized into sections reviewing the LEST cells, LSCD and various stem cell-based approaches for treating LSCD and discussing future direction and challenges. PMID:25278795

  15. Assessment of skin blood flow following spinal manual therapy: a systematic review.

    PubMed

    Zegarra-Parodi, Rafael; Park, Peter Yong Soo; Heath, Deborah M; Makin, Inder Raj S; Degenhardt, Brian F; Roustit, Matthieu

    2015-04-01

    Skin blood flow (SBF) indexes have been used to describe physiological mechanisms associated with spinal manual therapy (SMT). The aims of the current review were to assess methods for data collection, assess how investigators interpreted SBF changes, and formulate recommendations to advance manual medicine research. A database search was performed in PubMed, Cochrane Library, the Physiotherapy Evidence Database, and the Cumulative Index to Nursing and Allied Health Literature through April 2014. Articles were included if at least 1 outcome measure was changes in 1 SBF index following SMT. The database search yielded 344 records. Two independent authors applied the inclusion criteria. Twenty studies met the inclusion criteria. Selected studies used heterogeneous methods to assess short-term post-SMT changes in SBF, usually vasoconstriction, which was interpreted as a general sympathoexcitatory effect through central mechanisms. However, this conclusion might be challenged by the current understanding of skin sympathetic nervous activity over local endothelial mechanisms that are specifically controlling SBF. Evaluation of SBF measurements in peripheral tissues following SMT may document physiological responses that are beyond peripheral sympathetic function. Based on the current use of SBF indexes in clinical and physiological research, 14 recommendations for advancing manual medicine research using laser Doppler flowmetry are presented. PMID:25261088

  16. Light and laser therapies for the treatment of sebaceous gland hyperplasia a review of the literature.

    PubMed

    Simmons, B J; Griffith, R D; Falto-Aizpurua, L A; Bray, F N; Nouri, K

    2015-11-01

    Sebaceous gland hyperplasia (SGH) is a benign cutaneous condition that presents primarily on the face and increases with UVB exposure and ageing. These lesions are a common cosmetic concern but are difficult to treat, as the entire sebaceous gland needs to be destroyed to prevent recurrence. Traditional methods of treatment include: cryosurgery, electrodessication, curettage, shave excision and topical trichloroacetic acid. These methods have an increased risk of skin discoloration and scarring to the area of treatment that may lead to inferior cosmetic outcomes. Alternatively, oral isotretinoin can treat SGH, but is a known teratogen in pregnancy and has high relapse rates with discontinuation. A systematic review of the literature was performed to look at photodynamic therapy (PDT) and laser treatment for SGH. According to the results of this study, PDT, lasers and combinations of the two treatments were found to offer alternatives to the more conventional techniques with better outcomes. In particular, the use of wavelength-specific laser for the sebaceous gland of 1720 nm were found to have better outcomes and provide minimal damage to surrounding tissues. Additionally, combination PDT with aminolevulinic acid and pre-treatment with carbon dioxide laser ablation or pulse-dyed laser offered higher cure rates over stand-alone laser or PDT treatments in a shorter number of sessions with similar transient side-effects. However, further large-scale prospective studies with adequate follow-up are required to confirm these findings and those for sebaceous gland-specific lasers. PMID:25731611

  17. Imperative Role of Dental Pulp Stem Cells in Regenerative Therapies: A Systematic Review

    PubMed Central

    Kabir, Ramchandra; Gupta, Manish; Aggarwal, Avanti; Sharma, Deepak; Sarin, Anurag; Kola, Mohammed Zaheer

    2014-01-01

    Stem cells are primitive cells that can differentiate and regenerate organs in different parts of the body such as heart, bones, muscles and nervous system. This has been a field of great clinical interest with immense possibilities of using the stem cells in regeneration of human organ those are damaged due to disease, developmental defects and accident. The knowledge of stem cell technology is increasing quickly in all medical specialties and in dental field too. Stem cells of dental origin appears to hold the key to various cell-based therapies in regenerative medicine, but most avenues are in experimental stages and many procedures are undergoing standardization and validation. Long-term preservation of SHED cells or DPSC is becoming a popular consideration, similar to the banking of umbilical cord blood. Dental pulp stem cells (DPSCs) are the adult multipotent cells that reside in the cell rich zone of the dental pulp. The multipotent nature of these DPSCs may be utilized in both dental and medical applications. A systematic review of the literature was performed using various internet based search engines (PubMed, Medline Plus, Cochrane, Medknow, Ebsco, Science Direct, Hinari, WebMD, IndMed, Embase) using keywords like “dental pulp stem cells”, “regeneration”, “medical applications”, “tissue engineering”. DPSCs appears to be a promising innovation for the re-growth of tissues however, long term clinical studies need to be carried out that could establish some authentic guidelines in this perspective. PMID:24665194

  18. Intravesical Therapy for Urothelial Carcinoma of the Urinary Bladder: A Critical Review

    PubMed Central

    Chade, Daher C.; Shariat, Shahrokh F.; Dalbagni, Guido

    2014-01-01

    The management of non-muscle-invasive urothelial carcinoma of the bladder (UCB) is a challenge for physicians and patients alike. This is largely due to the heterogeneous natural history of this disease, in which tumors range from indolent to rapidly progressive and eventually fatal. Moreover, the high rate of recurrence and progression cause significant morbidity, expense, and detriment to quality of life. The advent of effective and safe intravesical therapies has improved the management of non-muscle-invasive UCB. Nevertheless, despite over 30 years of research and clinical experience, the mechanism, risks, benefits, and optimal regimens and treatment algorithms remain unclear. Although immunotherapy with bacillus Calmette-Guerin (BCG) has been the mainstay of intravesical treatment and represents a significant advance in the interaction of immunology and oncology, its clinical effectiveness is accompanied by a wide range of adverse events. Here, we review the literature on intravesical immunotherapy and chemotherapy with the aim of evaluating the clinical utility of the different treatments and providing recommendations. Many studies over the years have compared efficacy and toxicities of different agents and regimens, and certain conclusions are now well supported by high-level evidence. Future perspectives and promising advances in drug development are discussed and areas of improvement are identified in order to promote better cancer control and decrease the rate and severity of side-effects. PMID:20028569

  19. Intravesical therapy for urothelial carcinoma of the urinary bladder: a critical review.

    PubMed

    Chade, Daher C; Shariat, Shahrokh F; Dalbagni, Guido

    2009-01-01

    The management of non-muscle-invasive urothelial carcinoma of the bladder (UCB) is a challenge for physicians and patients alike. This is largely due to the heterogeneous natural history of this disease, in which tumors range from indolent to rapidly progressive and eventually fatal. Moreover, the high rate of recurrence and progression cause significant morbidity, expense, and detriment to quality of life. The advent of effective and safe intravesical therapies has improved the management of non-muscle-invasive UCB. Nevertheless, despite over 30 years of research and clinical experience, the mechanism, risks, benefits, and optimal regimens and treatment algorithms remain unclear. Although immunotherapy with bacillus Calmette-Guerin (BCG) has been the mainstay of intravesical treatment and represents a significant advance in the interaction of immunology and oncology, its clinical effectiveness is accompanied by a wide range of adverse events. Here, we review the literature on intravesical immunotherapy and chemotherapy with the aim of evaluating the clinical utility of the different treatments and providing recommendations. Many studies over the years have compared efficacy and toxicities of different agents and regimens, and certain conclusions are now well supported by high-level evidence. Future perspectives and promising advances in drug development are discussed and areas of improvement are identified in order to promote better cancer control and decrease the rate and severity of side-effects. PMID:20028569

  20. Electroconvulsive Therapy Treatment in a Patient With Neurosyphilis and Psychotic Disorder: Case Report and Literature Review.

    PubMed

    Pecenak, Jan; Janik, Peter; Vaseckova, Barbora; Trebulova, Kristina

    2015-12-01

    Syphilis is an infectious disease caused by Treponema pallidum that presents clinically in different ways. Over recent years, an upsurge of new cases of syphilis has been reported, often in combination with human immunodeficiency virus infection. The clinical picture is changing because of the widespread use of antibiotics, and psychiatric manifestations may be the main reason why patients seek medical help. In most cases, treatment with penicillin and psychotropic medication is effective. Electroconvulsive therapy (ECT) is rarely used for the psychiatric manifestations of neurosyphilis: we identified only 19 cases in the literature. We report here on a 40-year-old man newly diagnosed with neurosyphilis during hospitalization for a psychotic state with depression and also review the literature. He was treated with 2 courses of penicillin and several antipsychotics. The ECT was indicated because he failed to respond well to antipsychotic treatment and developed a high risk of dangerous behavior. A series of 8 sessions of ECT rapidly relieved the psychotic symptoms. PMID:25634568

  1. A Review of Intraoperative Goal-Directed Therapy Using Arterial Waveform Analysis for Assessment of Cardiac Output

    PubMed Central

    Fernandez-Bustamante, Ana

    2014-01-01

    Increasing evidence shows that goal-directed hemodynamic management can improve outcomes in surgical and intensive care settings. Arterial waveform analysis is one of the different techniques used for guiding goal-directed therapy. Multiple proprietary systems have developed algorithms for obtaining cardiac output from an arterial waveform, including the FloTrac, LiDCO, and PiCCO systems. These systems vary in terms of how they analyze the arterial pressure waveform as well as their requirements for invasive line placement and calibration. Although small-scale clinical trials using these monitors show promising data, large-scale multicenter trials are still needed to better determine how intraoperative goal-directed therapy with arterial waveform analysis can improve patient outcomes. This review provides a comparative analysis of the different arterial waveform monitors for intraoperative goal-directed therapy. PMID:24987744

  2. Understanding patients’ perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review

    PubMed Central

    Chee, Ying Jie; Chan, Hian Hui Vincent; Tan, Ngiap Chuan

    2014-01-01

    INTRODUCTION Dyslipidaemia leads to atherosclerosis and is a major risk factor for cardiovascular diseases. In clinical trials, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been shown to effectively reduce dyslipidaemia. Despite the availability and accessibility of statins, myocardial infarctions and cerebrovascular accidents remain among the top causes of mortality in developed countries, including Singapore. This enigma could be attributed to suboptimal adherence to statin therapy. The present literature review aimed to evaluate patients’ perceptions of statin therapy. METHODS We searched PubMed and other databases for articles published in English from October 1991 to May 2012 containing keywords such as ‘patient’, ‘views’, ‘perceptions’, ‘adherence’, ‘statin’ and ‘dyslipidaemia’. Of the 122 eligible studies retrieved, 58 were reviewed. The findings were categorised and framed in accordance with the Health Belief Model. RESULTS Patients with dyslipidaemia appeared to underestimate their susceptibility to dyslipidaemia-related complications, partly due to their demographic profiles. Failure to appreciate the severity of potential complications was a major hindrance toward adherence to statin therapy. Other factors that affected a patient’s adherence included lack of perceived benefits, perceived side effects, the cost of statins, poor physician-patient relationship, and overestimation of the effectiveness of diet control as a treatment modality. CONCLUSION Existing evidence suggests that the cause of poor adherence to statin therapy is multifactorial. The use of the Health Belief Model to present the results of our literature review provides a systematic framework that could be used to design a patient-centric approach for enhancing adherence to statin therapy. PMID:25189302

  3. A Review of Antidepressant Therapy in Primary Care: Current Practices and Future Directions

    PubMed Central

    2013-01-01

    Objective: To provide general practitioners with a comparison of major depressive disorder treatments received in primary care and psychiatric clinic settings, a focus on treatment outcomes related to currently prescribed antidepressants, and a review of new and emerging therapeutic strategies. Data Sources: English-language evidence-based guidelines and peer-reviewed literature published between January 1, 2005, and December 31, 2011, were identified using PubMed, MEDLINE, and EMBASE. All searches contained the terms major depressive disorder and unipolar depression, and excluded the terms bipolar disorder/manic depressive disorder. The following search terms were also included: naturalistic study, antidepressant, relapse, recurrence, residual symptoms, response, remission, sequential medication trials, and treatment-resistant depression. Study Selection: Meta-analyses, systematic reviews, and practice guidelines were included. Bibliographies were used to identify additional articles of interest. Data Extraction: Abstracts and articles were screened for relevance to primary care practice. Population-based studies and those involving patients treated in primary care were used whenever possible. Data Synthesis: Achieving remission from a major depressive episode is important to improve functional outcomes and to reduce relapse and recurrence. Despite the availability of numerous antidepressants, as many as 50% of patients require treatment modifications beyond first-line therapy. Among remitters, 90% report residual symptoms that may interfere with function. Patients treated in primary care often have chronic depression (symptom duration ? 24 months at presentation) and medical comorbidities. These are clinical predictors of worse outcomes and require individualized attention when treatment is initiated. Antidepressants differ in efficacy, tolerability, and side effects—factors that may affect adherence to treatment. Conclusions: Major depressive disorder is highly prevalent in primary care and is among the most common causes of loss of disability-adjusted life-years worldwide. There are few differences in clinical profiles between depressed patients in primary care and those in specialist clinics, although differences in symptoms and comorbid conditions among individual depressed patients present a challenge for the physician providing individualized treatment. The goal of treatment is remission with good functional and psychosocial outcomes. Physicians in primary care should have expertise in working with a number of current antidepressant approaches and an awareness of new and emerging treatments. PMID:23930234

  4. Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

    PubMed Central

    Freedman, Stephen B.; Pasichnyk, Dion; Black, Karen J. L.; Fitzpatrick, Eleanor; Gouin, Serge; Milne, Andrea; Hartling, Lisa

    2015-01-01

    Context Gastroenteritis remains a leading cause of childhood morbidity. Objective Because prior reviews have focused on isolated symptoms and studies conducted in developing countries, this study focused on interventions commonly considered for use in developed countries. Intervention specific, patient-centered outcomes were selected. Data Sources MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings. Study Selection Randomized controlled trials, conducted in developed countries, of children aged <18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate. Data Extraction The study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models. Results 31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hospitalization (RR 0.80, 95%CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95%CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic required intravenous rehydration (RR 0.40, 95%CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three studies evaluated hospitalization within 7 days (RR 0.87, 95%CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92). Conclusions There is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitalization. No benefits were associated with ondansetron use following emergency department discharge. PMID:26075617

  5. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review

    PubMed Central

    2012-01-01

    Background Although there is evidence that spinal manipulative therapy (SMT) can reduce pain, the mechanisms involved are not well established. There is a need to review the scientific literature to establish the evidence-base for the reduction of pain following SMT. Objectives To determine if SMT can reduce experimentally induced pain, and if so, if the effect is i) only at the level of the treated spinal segment, ii) broader but in the same general region as SMT is performed, or iii) systemic. Design A systematic critical literature review. Methods A systematic search was performed for experimental studies on healthy volunteers and people without chronic syndromes, in which the immediate effect of SMT was tested. Articles selected were reviewed blindly by two authors. A summary quality score was calculated to indicate level of manuscript quality. Outcome was considered positive if the pain-reducing effect was statistically significant. Separate evidence tables were constructed with information relevant to each research question. Results were interpreted taking into account their manuscript quality. Results Twenty-two articles were included, describing 43 experiments, primarily on pain produced by pressure (n?=?27) or temperature (n?=?9). Their quality was generally moderate. A hypoalgesic effect was shown in 19/27 experiments on pressure pain, produced by pressure in 3/9 on pain produced by temperature and in 6/7 tests on pain induced by other measures. Second pain provoked by temperature seems to respond to SMT but not first pain. Most studies revealed a local or regional hypoalgesic effect whereas a systematic effect was unclear. Manipulation of a “restricted motion segment” (“manipulable lesion”) seemed not to be essential to analgesia. In relation to outcome, there was no discernible difference between studies with higher vs. lower quality scores. Conclusions These results indicate that SMT has a direct local/regional hypoalgesic effect on experimental pain for some types of stimuli. Further research is needed to determine i) if there is also a systemic effect, ii) the exact mechanisms by which SMT attenuates pain, and iii) whether this response is clinically significant. PMID:22883534

  6. Economic Evaluation of Pharmaco- and Behavioral Therapies for Smoking Cessation: A Critical and Systematic Review of Empirical Research

    PubMed Central

    Ruger, Jennifer Prah; Lazar, Christina M.

    2014-01-01

    Economic evaluations are an important tool to improve our understanding of the costs and effects of health care services and to create sustainable health care systems. This article critically assesses empirical evidence from economic evaluations of pharmaco- and behavioral therapies for smoking cessation. A comprehensive literature review of PubMed and the British National Health Service Economic Evaluation Database was conducted. The search identified 15 articles on nicotine-based pharmacotherapies, 12 articles on nonnicotine based pharmacotherapies, no articles on selegiline, and 10 articles on brief counseling for smoking cessation treatment. Results show that both pharmaco- and behavioral therapies for smoking cessation are cost-effective or even cost-saving. The review highlights several shortcomings in methodology and a lack of standardization of current economic evaluations. Efforts to improve methodology will help make future studies more comparable and increase the evidence base so that such evaluations can be more useful to public health practitioners and policy makers. PMID:22224889

  7. Silver (Ag) Transport Mechanisms in TRISO coated particles: A Critical Review

    SciTech Connect

    I J van Rooyen; J H Neethling; J A A Engelbrecht; P M van Rooyen; G Strydom

    2012-10-01

    Transport of 110mAg in the intact SiC layer of TRISO coated particles has been studied for approximately 30 years without arriving at a satisfactory explanation of the transport mechanism. In this paper the possible mechanisms postulated in previous experimental studies, both in-reactor and out-of reactor research environment studies are critically reviewed and of particular interest are relevance to very high temperature gas reactor operating and accident conditions. Among the factors thought to influence Ag transport are grain boundary stoichiometry, SiC grain size and shape, the presence of free silicon, nano-cracks, thermal decomposition, palladium attack, transmutation products, layer thinning and coated particle shape. Additionally new insight to nature and location of fission products has been gained via recent post irradiation electron microscopy examination of TRISO coated particles from the DOE’s fuel development program. The combined effect of critical review and new analyses indicates a direction for investigating possible the Ag transport mechanism including the confidence level with which these mechanisms may be experimentally verified.

  8. Silver (Ag) Transport Mechanisms in TRISO Coated Particles: A Critical Review

    SciTech Connect

    IJ van Rooyen; ML Dunzik-Gougar; PM van Rooyen

    2014-05-01

    Transport of 110mAg in the intact SiC layer of TRISO coated particles has been studied for approximately 30 years without arriving at a satisfactory explanation of the transport mechanism. In this paper the possible mechanisms postulated in previous experimental studies, both in-reactor and out-of reactor research environment studies are critically reviewed and of particular interest are relevance to very high temperature gas reactor operating and accident conditions. Among the factors thought to influence Ag transport are grain boundary stoichiometry, SiC grain size and shape, the presence of free silicon, nano-cracks, thermal decomposition, palladium attack, transmutation products, layer thinning and coated particle shape. Additionally new insight to nature and location of fission products has been gained via recent post irradiation electron microscopy examination of TRISO coated particles from the DOE’s fuel development program. The combined effect of critical review and new analyses indicates a direction for investigating possible the Ag transport mechanism including the confidence level with which these mechanisms may be experimentally verified.

  9. Fundamentals and application of magnetic particles in cell isolation and enrichment: a review

    NASA Astrophysics Data System (ADS)

    Plouffe, Brian D.; Murthy, Shashi K.; Lewis, Laura H.

    2015-01-01

    Magnetic sorting using magnetic beads has become a routine methodology for the separation of key cell populations from biological suspensions. Due to the inherent ability of magnets to provide forces at a distance, magnetic cell manipulation is now a standardized process step in numerous processes in tissue engineering, medicine, and in fundamental biological research. Herein we review the current status of magnetic particles to enable isolation and separation of cells, with a strong focus on the fundamental governing physical phenomena, properties and syntheses of magnetic particles and on current applications of magnet-based cell separation in laboratory and clinical settings. We highlight the contribution of cell separation to biomedical research and medicine and detail modern cell-separation methods (both magnetic and non-magnetic). In addition to a review of the current state-of-the-art in magnet-based cell sorting, we discuss current challenges and available opportunities for further research, development and commercialization of magnetic particle-based cell-separation systems.

  10. The effect of complementary therapies on post-operative pain control in ambulatory knee surgery: a systematic review.

    PubMed

    Barlow, Timothy; Downham, Christopher; Barlow, David

    2013-10-01

    Ambulatory knee surgery is a common procedure with over 100,000 knee arthroscopies performed in the U.K. in 2010-2011. Pain after surgery can decrease patient satisfaction, delay discharge, and decrease cost effectiveness. Multi-modal therapies, including complementary therapies, to improve pain control after surgery have been recommended. However, a comprehensive review of the literature regarding the use of complementary therapies to enhance pain control after ambulatory knee surgery is lacking, and this article aims to address this deficit. CINHAL, EMBASE, MEDLINE, AMED and CENTRAL databases were searched. Only Randomised Controlled Trials were included. All eligible papers were quality assessed using the Jadad system, and data was extracted using piloted forms. Two independent reviewers performed each stage of the review. Full details of the study methodology can be found on Prospero, a systematic review register. Five studies satisfied our eligibility criteria: three reporting on acupuncture, one on homeopathy, and one on acupoints. Acupoint pressure was the only study that demonstrated reduced pain compared with placebo. This study was the least methodologically robust. Arnica, although demonstrating a significant reduction in swelling, did not affect post-operative pain. Acupuncture did not affect post-operative pain; however, a reduction in ibuprofen use was demonstrated in two studies. Before recommending complementary therapy for routine use in ambulatory knee surgery, further work is required. Two areas of future research likely to bear fruit are demonstrating robust evidence for the effect of acupoint pressure on post-operative pain, and quantifying the positive effect of homeopathic arnica on post-operative swelling. PMID:24050592

  11. Telerehabilitation Store and Forward Applications: A Review of Applications and Privacy Considerations in Physical and Occupational Therapy Practice

    PubMed Central

    PETERSON, CHRISTOPHER; WATZLAF, VALERIE

    2015-01-01

    An overview of store and forward applications commonly used in physical and occupational therapy practice is reviewed with respect to regulation, privacy, security, and clinical applications. A privacy and security checklist provides a clear reference of pertinent regulatory issues regarding these software applications. A case study format is used to highlight clinical applications of store and forward software features. Important considerations of successful implementation of store and forward applications are also identified and discussed. PMID:25945231

  12. A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria.

    PubMed

    Seal, Leighton J

    2016-01-01

    This review focuses on the effect that cross-gender sex steroid therapy has on metabolic and hormonal parameters. There is an emphasis on those changes that result in significant clinical effects such as the positive effects of the development of secondary sexual characteristics and negative effects such as haemostatic effects and thromboembolism in transwomen or dyslipidaemia in transmen. There is also a description of the current hormonal regimens used at the largest UK gender identity clinic. The overall safety of these treatments in the context of long-term outcome data is reviewed. PMID:25933804

  13. Combination Therapy with Cholinesterase Inhibitors and Memantine for Alzheimer’s Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Kishi, Taro; Iwata, Nakao

    2015-01-01

    Background: We performed an updated meta-analysis of randomized controlled trials of combination therapy with cholinesterase inhibitors and memantine in patients with Alzheimer’s disease. Methods: We reviewed cognitive function, activities of daily living, behavioral disturbance, global assessment, discontinuation rate, and individual side effects. Results: Seven studies (total n=2182) were identified. Combination therapy significantly affected behavioral disturbance scores (standardized mean difference=?0.13), activity of daily living scores (standardized mean difference=?0.10), and global assessment scores (standardized mean difference=?0.15). In addition, cognitive function scores (standardized mean difference=?0.13, P=.06) exhibited favorable trends with combination therapy. The effects of combination therapy were more significant in the moderate-to-severe Alzheimer’s disease subgroup in terms of all efficacy outcome scores. The discontinuation rate was similar in both groups, and there were no significant differences in individual side effects. Conclusions: Combination therapy was beneficial for the treatment of moderate-to-severe Alzheimer’s disease in terms of cognition, behavioral disturbances, activities of daily living, and global assessment was well tolerated. PMID:25548104

  14. Psychological Therapies in Patients with Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Altayar, Osama; Prokop, Larry J.; Sood, Amit; Murad, Mohammad Hassan

    2015-01-01

    Background. Irritable bowel syndrome (IBS) is a poorly understood disease with few effective treatments. Psychosocial factors are believed to contribute to the pathogenesis of IBS. Objective. To evaluate the evidence for psychological therapies in IBS treatment. Methods. We searched six medical databases through February 6, 2014, for randomized controlled trials (RCTs) of psychological therapies for the treatment of IBS. Two independent reviewers identified the RCTs, extracted the data, and assessed trial quality. We used the random-effect model to pool standardized mean difference (SMD) and 95% confidence interval (CI) across trials. Results. 15 RCTs that mostly evaluated cognitive behavioral therapy were included. Psychological therapies were associated with improvement in IBS symptoms severity scales (SMD ?0.618; 95% CI: ?0.853 to ?0.383), IBS-Quality of Life (SMD 0.604; 95% CI: 0.440 to 0.768), and abdominal pain (SMD ?0.282; 95% CI: ?0.562 to ?0.001). No statistically significant effect was observed on diarrhea or constipation. Limitations. The trials were at increased risk of bias and the overall sample size was small leading to imprecision. Conclusion. Psychological therapies may improve the quality of life and symptom severity in IBS. The effect size noted is moderate to large and is clinically meaningful. PMID:25802514

  15. Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis.

    PubMed

    Ueda, Tomomi; Suzukamo, Yoshimi; Sato, Mai; Izumi, Shin-Ichi

    2013-03-01

    Behavioral and psychological symptoms of dementia (BPSD) are common problems for patients and caregivers. Although music therapy is considered a non-pharmacological intervention for the management of BPSD, its effectiveness remains unclear. This study aimed to investigate the effects of music therapy on BPSD, cognitive function, and activities of daily living in patients with dementia. A literature search was conducted in the following databases: MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi. We selected 20 studies, including randomized controlled trials, controlled clinical trials, cohort studies, and controlled trials, and conducted a meta-analysis using standardized mean differences (SMD). The results showed that music therapy had moderate effects on anxiety [SMD, -0.64; 95% confidence interval (CI), -1.05 - -0.24; p=0.002] and small effects on behavioral symptoms (SMD, -0.49; 95% CI, -0.82 - -0.17; p=0.003). In studies of duration >3 months, music therapy had large effects on anxiety (SMD, -0.93; 95% CI, -1.72 - -0.13; p=0.02). The present systematic review and meta-analysis suggests that music therapy is effective for the management of BPSD. PMID:23511664

  16. E-therapy in the treatment and prevention of eating disorders: A systematic review and meta-analysis

    PubMed Central

    Loucas, Christina E.; Fairburn, Christopher G.; Whittington, Craig; Pennant, Mary E.; Stockton, Sarah; Kendall, Tim

    2014-01-01

    The widespread availability of the Internet and mobile-device applications (apps) is changing the treatment of mental health problems. The aim of the present study was to review the research on the effectiveness of e-therapy for eating disorders, using the methodology employed by the UK's National Institute for Health and Care Excellence (NICE). Electronic databases were searched for published randomised controlled trials of e-therapies, designed to prevent or treat any eating disorder in all age groups. Studies were meta-analysed where possible, and effect sizes with confidence intervals were calculated. The GRADE approach was used to determine the confidence in the effect estimates. Twenty trials met the inclusion criteria. For prevention, a CBT-based e-intervention was associated with small reductions in eating disorder psychopathology, weight concern and drive for thinness, with moderate confidence in the effect estimates. For treatment and relapse prevention, various e-therapies showed some beneficial effects, but for most outcomes, evidence came from single studies and confidence in the effect estimates was low. Overall, although some positive findings were identified, the value of e-therapy for eating disorders must be viewed as uncertain. Further research, with improved methods, is needed to establish the effectiveness of e-therapy for people with eating disorders. PMID:25461787

  17. Rationale for and Review of Neoadjuvant Therapy Prior to Radical Prostatectomy for Patients with High-Risk Prostate Cancer

    PubMed Central

    McKay, Rana R.; Choueiri, Toni K.; Taplin, Mary-Ellen

    2014-01-01

    Despite state of the art local therapy a significant portion of men with high-risk prostate cancer develop progressive disease. Neoadjuvant systemic therapy prior to radical prostatectomy (RP) is an approach which can potentially maximize survival outcomes in patients with localized disease. This approach is under investigation with a wide array of agents and provides an opportunity to assess pathologic and biologic activity of novel treatments. The aim of this review is to explore the past and present role of neoadjuvant therapy prior to definitive therapy with RP in patients with high-risk localized or locally advanced disease. The results of neoadjuvant ADT, including use of newer agents such as abiraterone and enzalutamide, are promising. Neoadjuvant chemotherapy, primarily with docetaxel, with or without ADT has also demonstrated efficacy in men with high-risk disease. Other novel agents targeting the vascular endothelial growth factor receptor (VEGFR), epidermal growth factor receptor (EGFR), platelet derived growth factor receptor (PDGFR), clusterin, and the immune system are currently under investigation and have led to variable results in early clinical trials. Despite optimistic data, approval of neoadjuvant therapy prior to RP in patients with high-risk prostate cancer will depend on positive results from well designed phase III trials. PMID:23943203

  18. Dose-response relationship in music therapy for people with serious mental disorders: systematic review and meta-analysis.

    PubMed

    Gold, Christian; Solli, Hans Petter; Krüger, Viggo; Lie, Stein Atle

    2009-04-01

    Serious mental disorders have considerable individual and societal impact, and traditional treatments may show limited effects. Music therapy may be beneficial in psychosis and depression, including treatment-resistant cases. The aim of this review was to examine the benefits of music therapy for people with serious mental disorders. All existing prospective studies were combined using mixed-effects meta-analysis models, allowing to examine the influence of study design (RCT vs. CCT vs. pre-post study), type of disorder (psychotic vs. non-psychotic), and number of sessions. Results showed that music therapy, when added to standard care, has strong and significant effects on global state, general symptoms, negative symptoms, depression, anxiety, functioning, and musical engagement. Significant dose-effect relationships were identified for general, negative, and depressive symptoms, as well as functioning, with explained variance ranging from 73% to 78%. Small effect sizes for these outcomes are achieved after 3 to 10, large effects after 16 to 51 sessions. The findings suggest that music therapy is an effective treatment which helps people with psychotic and non-psychotic severe mental disorders to improve global state, symptoms, and functioning. Slight improvements can be seen with a few therapy sessions, but longer courses or more frequent sessions are needed to achieve more substantial benefits. PMID:19269725

  19. Systematic Review and Meta-Analysis of Combination Therapy with Cholinesterase Inhibitors and Memantine in Alzheimer's Disease and Other Dementias

    PubMed Central

    Muayqil, Taim; Camicioli, Richard

    2012-01-01

    Background N-methyl-D-aspartic acid antagonists (memantine) and cholinesterase inhibitors (ChEIs) are the only two approved classes of drugs to treat dementia; this paper explores the evidence for using these two treatments in combination. Objective To determine the efficacy and safety of using combination therapy with memantine and a ChEI to treat dementia in comparison to monotherapy with either memantine or a ChEI. Methods In March 2012, we systematically searched MEDLINE/PubMed, EMBASE, Cochrane library, and grey literature databases. All study types were included, except for case series or reports, which looked at combination therapy versus monotherapy in various dementing disorders. Data was pooled for blinded randomized controlled trials (RCTs) only; mean differences and standardized mean differences were used to determine effect sizes. Results Thirteen studies were included in this review; 3 were blinded RCTs, with a total of 971 Alzheimer's disease (AD) patients, which were included into the meta-analysis. No papers were found that primarily addressed combination therapy in other dementias. In the meta-analysis, small but statistically significant effect sizes were seen in favor of combination therapy among patients with moderate to severe AD on the scales of cognition (0.45–0.52; p < 0.0001), scales of functional outcomes (0.23–0.3; p < 0.01), and the neuropsychiatric inventory (3.7–4.4; p < 0.0001). Among the open-label studies, 3 out of 6 suggested benefits, as did the 4 included cohort studies. However, the high risk of bias encountered in the latter two study designs limits deducing any conclusions about benefit. Conclusion Although there were statistically significant changes in favor of combination therapy in moderate to severe AD, heterogeneity in scales and patient characteristics exists. However, it is unclear if clinically significant outcomes can be achieved using the combination therapy. More studies are required before a recommendation for combination therapy can be made. PMID:23277787

  20. Pharmacokinetic drug interactions with clopidogrel: updated review and risk management in combination therapy

    PubMed Central

    Wang, Zhi-Yu; Chen, Meng; Zhu, Ling-Ling; Yu, Lu-Shan; Zeng, Su; Xiang, Mei-Xiang; Zhou, Quan

    2015-01-01

    Background Coprescribing of clopidogrel and other drugs is common. Available reviews have addressed the drug–drug interactions (DDIs) when clopidogrel is as an object drug, or focused on combination use of clopidogrel and a special class of drugs. Clinicians may still be ignorant of those DDIs when clopidogrel is a precipitant drug, the factors determining the degree of DDIs, and corresponding risk management. Methods A literature search was performed using PubMed, MEDLINE, Web of Science, and the Cochrane Library to analyze the pharmacokinetic DDIs of clopidogrel and new P2Y12 receptor inhibitors. Results Clopidogrel affects the pharmacokinetics of cerivastatin, repaglinide, ferulic acid, sibutramine, efavirenz, and omeprazole. Low efficacy of clopidogrel is anticipated in the presence of omeprazole, esomeprazole, morphine, grapefruit juice, scutellarin, fluoxetine, azole antifungals, calcium channel blockers, sulfonylureas, and ritonavir. Augmented antiplatelet effects are anticipated when clopidogrel is coprescribed with aspirin, curcumin, cyclosporin, St John’s wort, rifampicin, and angiotensin-converting enzyme inhibitors. The factors determining the degree of DDIs with clopidogrel include genetic status (eg, cytochrome P540 [CYP]2B6*6, CYP2C19 polymorphism, CYP3A5*3, CYP3A4*1G, and CYP1A2-163C.A), species differences, and dose strength. The DDI risk does not exhibit a class effect, eg, the effects of clopidogrel on cerivastatin versus other statins, the effects of proton pump inhibitors on clopidogrel (omeprazole, esomeprazole versus pantoprazole, rabeprazole), the effects of rifampicin on clopidogrel versus ticagrelor and prasugrel, and the effects of calcium channel blockers on clopidogrel (amlodipine versus P-glycoprotein-inhibiting calcium channel blockers). The mechanism of the DDIs with clopidogrel involves modulating CYP enzymes (eg, CYP2B6, CYP2C8, CYP2C19, and CYP3A4), paraoxonase-1, hepatic carboxylesterase 1, P-glycoprotein, and organic anion transporter family member 1B1. Conclusion Effective and safe clopidogrel combination therapy can be achieved by increasing the awareness of potential changes in efficacy and toxicity, rationally selecting alternatives, tailoring drug therapy based on genotype, checking the appropriateness of physician orders, and performing therapeutic monitoring. PMID:25848291

  1. Topical therapies for oral lichen planus management and their efficacy: a narrative review.

    PubMed

    Bagan, José; Compilato, Domenico; Paderni, Carlo; Campisi, Giuseppina; Panzarella, Vera; Picciotti, Maria; Lorenzini, Guido; Di Fede, Olga

    2012-01-01

    Oral Lichen Planus (OLP) is a chronic inflammatory condition implicating T cell-mediated cytotoxicity, and involving oral mucosal surfaces. Several therapeutic regimens have been evaluated to treat OLP and pain related, but often without high level of evidence. Topical formulations are the favourite for the majority of cases; bioadhesive formulations have been considered very useful and practical for local drug delivery in oral mucosa, due to the increased residence time on the oral mucosa of the dosage forms and better therapeutic efficacy. In this narrative review, authors try to illustrate the current topical managements for OLP from the accessible literature on this topic. Steroids are very helpful in discomfort and making better quality of life: they are considered the first-line treatment even if they could cause secondary candidosis, and sometimes bad taste, nausea, dry mouth, sore throat or swollen mouth. Other substances or devices by topical administration are adopted especially when the first line approach is refractory. This is the case when retinol with its synthetic and natural analogues (retinoids), hyaluronic acid, or Aloe Vera are chosen. Recent topical applications for OLP therapy include phototherapy and low/high energy pulsing light; the treatment with extracorporeal photochemotherapy is also reasonable and promising. Finally, calcineurin inhibitors (i.e. cyclosporine, tacrolimus and pimecrolimus), antioxidant and biologics (i.e alefacept, efalizumab, basiliximab, TNF-? inhibitors - infliximab, rituximab) may be alternative approaches when OLP does not respond to the standard protocols. In this scenario, there are several studies on molecules different from glucocorticosteroids, but not sufficient or statistically adequate to justify their evidence-based use in OLP; large randomized placebo controlled trials are required to evaluate the safety and effectiveness of these non conventional therapies. In conclusion, since OLP is a chronic disease and requires long-term management, the dental/medical practitioner, who treats OLP patients, needs to know the natural history of OLP, how to monitor, and how to treat, taking in account all of the available modalities conventional and not, with pros and cons. PMID:22632394

  2. Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Diseases. Comprehensive Review of the Recent Literature 2010–2012

    PubMed Central

    2013-01-01

    A conference, “Stem Cells and Cell Therapies in Lung Biology and Lung Diseases,” was held July 25 to 28, 2011 at the University of Vermont to review the current understanding of the role of stem and progenitor cells in lung repair after injury and to review the current status of cell therapy and ex vivo bioengineering approaches for lung diseases. These are rapidly expanding areas of study that provide further insight into and challenge traditional views of mechanisms of lung repair after injury and pathogenesis of several lung diseases. The goals of the conference were to summarize the current state of the field, to discuss and debate current controversies, and to identify future research directions and opportunities for basic and translational research in cell-based therapies for lung diseases. The goal of this article, which accompanies the formal conference report, is to provide a comprehensive review of the published literature in lung regenerative medicine from the last conference report through December 2012. PMID:23869446

  3. Science and engineering of nanodiamond particle surfaces for biological applications (Review).

    PubMed

    Shenderova, Olga A; McGuire, Gary E

    2015-01-01

    Diamond has outstanding bulk properties such as super hardness, chemical inertness, biocompatibility, luminescence, to name just a few. In the nanoworld, in order to exploit these outstanding bulk properties, the surfaces of nanodiamond (ND) particles must be accordingly engineered for specific applications. Modification of functional groups on the ND's surface and the corresponding electrostatic properties determine their colloidal stability in solvents, formation of photonic crystals, controlled adsorption and release of cargo molecules, conjugation with biomolecules and polymers, and cellular uptake. The optical activity of the luminescent color centers in NDs depends on their proximity to the ND's surface and surface termination. In order to engineer the ND surface, a fundamental understanding of the specific structural features and sp(3)-sp(2) phase transformations on the surface of ND particles is required. In the case of ND particles produced by detonation of carbon containing explosives (detonation ND), it should also be taken into account that its structure depends on the synthesis parameters and subsequent processing. Thus, for development of a strategy of surface modification of detonation ND, it is imperative to know details of its production. In this review, the authors discuss ND particles structure, strategies for surface modification, electrokinetic properties of NDs in suspensions, and conclude with a brief overview of the relevant bioapplications. PMID:26245200

  4. A review of measurement and modelling results of particle atmosphere-surface exchange

    NASA Astrophysics Data System (ADS)

    Pryor, S. C.; Gallagher, M.; Sievering, H.; Larsen, S. E.; Barthelmie, R. J.; Birsan, F.; Nemitz, E.; Rinne, J.; Kulmala, M.; Grönholm, T.; Taipale, R.; Vesala, T.

    2008-02-01

    Atmosphere-surface exchange represents one mechanism by which atmospheric particle mass and number size distributions are modified. Deposition velocities (vd) exhibit a pronounced dependence on surface type, due in part to turbulence structure (as manifest in friction velocity), with minima of approximately 0.01 and 0.2 cm s-1 over grasslands and 0.1-1 cm s-1 over forests. However, as noted over 20 yr ago, observations over forests generally do not support the pronounced minimum of deposition velocity (vd) for particle diameters of 0.1-2 ?m as manifest in theoretical predictions. Closer agreement between models and observations is found over less-rough surfaces though those data also imply substantially higher surface collection efficiencies than were originally proposed and are manifest in current models. We review theorized dependencies for particle fluxes, describe and critique model approaches and innovations in experimental approaches, and synthesize common conclusions of experimental and modelling studies. We end by proposing a number of research avenues that should be pursued in to facilitate further insights and development of improved numerical models of atmospheric particles.

  5. "The Master of Physical Therapy Program at the University of Saskatchewan has completed the accreditation review process administered by Physiotherapy Education Accreditation Canada (PEAC).

    E-print Network

    Saskatchewan, University of

    "The Master of Physical Therapy Program at the University of Saskatchewan has completed the accreditation review process administered by Physiotherapy Education Accreditation Canada (PEAC). PEAC for physiotherapy education programs in Canada. The status of Accreditation, Fully Compliant was granted

  6. Spectroscopy, Manipulation and Trapping of Neutral Atoms, Molecules, and Other Particles using Optical Nanofibers: A Review

    E-print Network

    Morrissey, Michael J; Frawley, Mary; Kumar, Ravi; Prel, Eugen; Russell, Laura; Truong, Viet Giang; Chormaic, Síle Nic

    2013-01-01

    The use of tapered optical fibers, i.e., optical nanofibers, for spectroscopy and the detection of small numbers of particles, such as neutral atoms or molecules, has been gaining ground in recent years. In this review, we briefly introduce the optical nanofiber, its fabrication and optical mode propagation within. We discuss recent progress on the integration of optical nanofibers into laser-cooled atom and vapor systems, paying particular attention to spectroscopy, cold atom cloud characterization and optical trapping schemes. Next, a natural extension on this work to molecules will be introduced. Finally, we consider several alternatives to optical nanofibers that display some advantages for particular applications.

  7. Spectroscopy, Manipulation and Trapping of Neutral Atoms, Molecules, and Other Particles Using Optical Nanofibers: A Review

    PubMed Central

    Morrissey, Michael J.; Deasy, Kieran; Frawley, Mary; Kumar, Ravi; Prel, Eugen; Russell, Laura; Truong, Viet Giang; Chormaic, Síle Nic

    2013-01-01

    The use of tapered optical fibers, i.e., optical nanofibers, for spectroscopy and the detection of small numbers of particles, such as neutral atoms or molecules, has been gaining interest in recent years. In this review, we briefly introduce the optical nanofiber, its fabrication, and optical mode propagation within. We discuss recent progress on the integration of optical nanofibers into laser-cooled atom and vapor systems, paying particular attention to spectroscopy, cold atom cloud characterization, and optical trapping schemes. Next, a natural extension of this work to molecules is introduced. Finally, we consider several alternatives to optical nanofibers that display some advantages for specific applications. PMID:23945738

  8. Radiation therapy

    MedlinePLUS

    Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells. ... faster than normal cells in the body. Because radiation is most harmful to quickly growing cells, radiation ...

  9. Proton Therapy

    MedlinePLUS

    ... for e-updates Please leave this field empty Proton Therapy SHARE Home > Treatment and Care > Treatments Listen ... a nucleus, which holds two types of particles—protons and neutrons. The nucleus is surrounded by electrons. ...

  10. Evaluation of resistive-plate-chamber-based TOF-PET applied to in-beam particle therapy monitoring

    NASA Astrophysics Data System (ADS)

    Torres-Espallardo, I.; Diblen, F.; Rohling, H.; Solevi, P.; Gillam, J.; Watts, D.; España, S.; Vandenberghe, S.; Fiedler, F.; Rafecas, M.

    2015-05-01

    Particle therapy is a highly conformal radiotherapy technique which reduces the dose deposited to the surrounding normal tissues. In order to fully exploit its advantages, treatment monitoring is necessary to minimize uncertainties related to the dose delivery. Up to now, the only clinically feasible technique for the monitoring of therapeutic irradiation with particle beams is Positron Emission Tomography (PET). In this work we have compared a Resistive Plate Chamber (RPC)-based PET scanner with a scintillation-crystal-based PET scanner for this application. In general, the main advantages of the RPC-PET system are its excellent timing resolution, low cost, and the possibility of building large area systems. We simulated a partial-ring scanner based on an RPC prototype under construction within the Fondazione per Adroterapia Oncologica (TERA). For comparison with the crystal-based PET scanner we have chosen the geometry of a commercially available PET scanner, the Philips Gemini TF. The coincidence time resolution used in the simulations takes into account the current achievable values as well as expected improvements of both technologies. Several scenarios (including patient data) have been simulated to evaluate the performance of different scanners. Initial results have shown that the low sensitivity of the RPC hampers its application to hadron-beam monitoring, which has an intrinsically low positron yield compared to diagnostic PET. In addition, for in-beam PET there is a further data loss due to the partial ring configuration. In order to improve the performance of the RPC-based scanner, an improved version of the RPC detector (modifying the thickness of the gas and glass layers), providing a larger sensitivity, has been simulated and compared with an axially extended version of the crystal-based device. The improved version of the RPC shows better performance than the prototype, but the extended version of the crystal-based PET outperforms all other options.

  11. Evaluation of resistive-plate-chamber-based TOF-PET applied to in-beam particle therapy monitoring.

    PubMed

    Torres-Espallardo, I; Diblen, F; Rohling, H; Solevi, P; Gillam, J; Watts, D; España, S; Vandenberghe, S; Fiedler, F; Rafecas, M

    2015-05-01

    Particle therapy is a highly conformal radiotherapy technique which reduces the dose deposited to the surrounding normal tissues. In order to fully exploit its advantages, treatment monitoring is necessary to minimize uncertainties related to the dose delivery. Up to now, the only clinically feasible technique for the monitoring of therapeutic irradiation with particle beams is Positron Emission Tomography (PET). In this work we have compared a Resistive Plate Chamber (RPC)-based PET scanner with a scintillation-crystal-based PET scanner for this application. In general, the main advantages of the RPC-PET system are its excellent timing resolution, low cost, and the possibility of building large area systems. We simulated a partial-ring scanner based on an RPC prototype under construction within the Fondazione per Adroterapia Oncologica (TERA). For comparison with the crystal-based PET scanner we have chosen the geometry of a commercially available PET scanner, the Philips Gemini TF. The coincidence time resolution used in the simulations takes into account the current achievable values as well as expected improvements of both technologies. Several scenarios (including patient data) have been simulated to evaluate the performance of different scanners. Initial results have shown that the low sensitivity of the RPC hampers its application to hadron-beam monitoring, which has an intrinsically low positron yield compared to diagnostic PET. In addition, for in-beam PET there is a further data loss due to the partial ring configuration. In order to improve the performance of the RPC-based scanner, an improved version of the RPC detector (modifying the thickness of the gas and glass layers), providing a larger sensitivity, has been simulated and compared with an axially extended version of the crystal-based device. The improved version of the RPC shows better performance than the prototype, but the extended version of the crystal-based PET outperforms all other options. PMID:25884991

  12. Safety and Efficacy of Nicotine Replacement Therapy in the Perioperative Period: A Narrative Review.

    PubMed

    Nolan, Margaret B; Warner, David O

    2015-11-01

    Patients who smoke cigarettes are at increased risk for development of complications both during and after surgical procedures, including respiratory, cardiac, and healing-related complications. Abstinence from smoking can considerably reduce these risks. Pharmacotherapy, including nicotine replacement therapy (NRT), is an important component of efficacious tobacco use interventions. However, the use of NRT in the perioperative period is controversial. In this narrative review, we discuss the current evidence for the efficacy and safety of NRT in patients scheduled for surgical procedures, with emphasis on evidence from human studies. We performed a literature search for articles published from January 1, 1990, through May 1, 2015, in the PubMed online database using various permutations of the Medical Subject Headings terms surgery; surgical procedures, operative; nicotine; and smoking cessation. Studies were selected for inclusion according to their relevance to the preclinical and clinical evidence pertaining to how NRT affects surgical outcome and long-term rates of abstinence from tobacco. There is strong evidence that NRT enhances the efficacy of tobacco use interventions. Some preclinical studies suggest that nicotine in high doses that exceed those produced by NRT decreases the viability of skin flaps. Although the available data are limited, there is no evidence from human studies that NRT increases the risk of healing-related or cardiovascular complications. Individual clinical trials of tobacco use interventions that include NRT have revealed either no effect or a reduction in complication rates. Therefore, given the benefits of smoking abstinence to both perioperative outcomes and long-term health and the efficacy of NRT in achieving and maintaining abstinence, any policies that prohibit the use of NRT in surgical patients should be reexamined. PMID:26455889

  13. Low-Level Laser Therapy for Fat Layer Reduction: A Comprehensive Review

    PubMed Central

    Avci, Pinar; Nyame, Theodore T.; Gupta, Gaurav K.; Sadasivam, Magesh; Hamblin, Michael R.

    2013-01-01

    Background and Objective Low-level laser (light) therapy (LLLT) is a noninvasive, nonthermal approach to disorders requiring reduction of pain and inflammation and stimulation of healing and tissue regeneration. Within the last decade, LLLT started being investigated as an adjuvant to liposuction, for noninvasive body contouring, reduction of cellulite, and improvement of blood lipid profile. LLLT may also aid autologous fat transfer procedures by enhancing the viability of adipocytes. However the underlying mechanism of actions for such effects still seems to be unclear. It is important, therefore, to understand the potential efficacy and proposed mechanism of actions of this new procedure for fat reduction. Materials and Methods A review of the literature associated with applications of LLLT related to fat layer reduction was performed to evaluate the findings from pre-clinical and clinical studies with respect to the mechanism of action, efficacy, and safety. Results The studies as of today suggest that LLLT has a potential to be used in fat and cellulite reduction as well as in improvement of blood lipid profile without any significant side effects. One of the main proposed mechanism of actions is based upon production of transient pores in adipocytes, allowing lipids to leak out. Another is through activation of the complement cascade which could cause induction of adipocyte apoptosis and subsequent release of lipids. Conclusion Although the present studies have demonstrated safety and efficacy of LLLT in fat layer reduction, studies demonstrating the efficacy of LLLT as a stand-alone procedure are still inadequate. Moreover, further studies are necessary to identify the mechanism of action. PMID:23749426

  14. Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review

    PubMed Central

    Kar, Nilamadhab

    2011-01-01

    Background: Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD. Methods: Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites. Results: The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT. Conclusion: There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action. PMID:21552319

  15. Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis

    PubMed Central

    Uthman, Olalekan A; Peltzer, Karl; Richardson, Lindsey A; Mills, Edward J; Amekudzi, Kofi; Ouédraogo, Alice

    2015-01-01

    Abstract Objective To assess the association between the employment status of human immunodeficiency virus (HIV)-infected individuals and adherence to antiretroviral therapy (ART). Methods We searched the Medline, Embase and Cochrane Central Register of Controlled Trials databases for studies reporting ART adherence and employment status published between January 1980 and September 2014. Information from a wide range of other sources, including the grey literature, was also analysed. Two independent reviewers extracted data on treatment adherence and study characteristics. Study data on the association between being employed and adhering to ART were pooled using a random-effects model. Between-study heterogeneity and sources of bias were evaluated. Findings The meta-analysis included 28 studies published between 1996 and 2014 that together involved 8743 HIV-infected individuals from 14 countries. The overall pooled odds ratio (OR) for the association between being employed and adhering to ART was 1.27 (95% confidence interval, CI: 1.04–1.55). The association was significant for studies from low-income countries (OR:?1.85, 95% CI: 1.58–2.18) and high-income countries (OR:?1.33, 95% CI: 1.02–1.74) but not middle-income countries (OR:?0.94, 95% CI: 0.62–1.42). In addition, studies published after 2011 and larger studies showed less association between employment and adherence than earlier and small studies, respectively. Conclusion Employed HIV-infected individuals, particularly those in low- and high-income countries, were more likely to adhere to ART than unemployed individuals. Further research is needed on the mechanisms by which employment and ART adherence affect each other and on whether employment-creation interventions can positively influence ART adherence, HIV disease progression and quality of life. PMID:25558105

  16. What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

    PubMed Central

    Veerbeek, Janne Marieke; van Wegen, Erwin; van Peppen, Roland; van der Wees, Philip Jan; Hendriks, Erik; Rietberg, Marc; Kwakkel, Gert

    2014-01-01

    Background Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. Methods and Findings Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N?=?25373; median PEDro score 6 [IQR 5–7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03–0.70; I2?=?0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84–4.11; I2?=?77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02–0.39; I2?=?6%) for motor function of the paretic arm to 0.61 (95%CI 0.41–0.82; I2?=?41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. Conclusions There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given. PMID:24505342

  17. Concise Review: Mind the Gap: Challenges in Characterizing and Quantifying Cell- and Tissue-Based Therapies for Clinical Translation

    PubMed Central

    Rayment, Erin A; Williams, David J

    2010-01-01

    There are many challenges associated with characterizing and quantifying cells for use in cell- and tissue-based therapies. From a regulatory perspective, these advanced treatments must not only be safe and effective but also be made by high-quality manufacturing processes that allow for on-time delivery of viable products. Although sterility assays can be adapted from conventional bioprocessing, cell- and tissue-based therapies require more stringent safety assessments, especially in relation to use of animal products, immune reaction, and potential instability due to extended culture times. Furthermore, cell manufacturers who plan to use human embryonic stem cells in their therapies need to be particularly stringent in their final purification steps, due to the unrestricted growth potential of these cells. This review summarizes the current issues in characterization and quantification for cell- and tissue-based therapies, dividing these challenges into the regulatory themes of safety, potency, and manufacturing quality. It outlines current assays in use, as well as highlights the limits of many of these product release tests. Mode of action is discussed, with particular reference to in vitro surrogate assays that can be used to provide information to correlate with proposed in vivo patient efficacy. Importantly, this review highlights the requirement for basic research to improve current knowledge on the in vivo fate of these treatments; as well as an improved stakeholder negotiation process to identify the measurement requirements that will ensure the manufacture of the best possible cell- and tissue-based therapies within the shortest timeframe for the most patient benefit. PMID:20333747

  18. Paving the Road for Modern Particle Therapy?–?What Can We Learn from the Experience Gained with Fast Neutron Therapy in Munich?

    PubMed Central

    Specht, Hanno M.; Neff, Teresa; Reuschel, Waltraud; Wagner, Franz M.; Kampfer, Severin; Wilkens, Jan J.; Petry, Winfried; Combs, Stephanie E.

    2015-01-01

    While neutron therapy was a highly topical subject in the 70s and 80s, today there are only a few remaining facilities offering fast neutron therapy (FNT). Nevertheless, up to today more than 30,000 patients were treated with neutron therapy. For some indications like salivary gland tumors and malignant melanoma, there is clinical evidence that the addition of FNT leads to superior local control compared to photon treatment alone. FNT was available in Munich from 1985 until 2000 at the Reactor Neutron Therapy (RENT) facility. Patient treatment continued at the new research reactor FRM II in 2007 under improved treatment conditions, and today it can still be offered to selected patients as an individual treatment option. As there is a growing interest in high-linear energy transfer (LET) therapy with new hadron therapy centers emerging around the globe, the clinical data generated by neutron therapy might help to develop biologically driven treatment planning algorithms. Also FNT might experience its resurgence as a combinational partner of modern immunotherapies. PMID:26640777

  19. VRE and VSE Bacteremia Outcomes in the Era of Effective VRE Therapy: A Systematic Review and Meta-analysis.

    PubMed

    Prematunge, Chatura; MacDougall, Colin; Johnstone, Jennie; Adomako, Kwaku; Lam, Freda; Robertson, Jennifer; Garber, Gary

    2016-01-01

    BACKGROUND Prior data suggest that vancomycin-resistant Enterococcus (VRE) bacteremia is associated with worse outcomes than vancomycin-sensitive Enterococcus (VSE) bacteremia. However, many studies evaluating such outcomes were conducted prior to the availability of effective VRE therapies. OBJECTIVE To systematically review VRE and VSE bacteremia outcomes among hospital patients in the era of effective VRE therapy. METHODS Electronic databases and grey literature published between January 1997 and December 2014 were searched to identify all primary research studies comparing outcomes of VRE and VSE bacteremias among hospital patients, following the availability of effective VRE therapies. The primary outcome was all-cause, in-hospital mortality, while total hospital length of stay (LOS) was a secondary outcome. All meta-analyses were conducted in Review Manager 5.3 using random-effects, inverse variance modeling. RESULTS Among all the studies reviewed, 12 cohort studies and 1 case control study met inclusion criteria. Similar study designs were combined in meta-analyses for mortality and LOS. VRE bacteremia was associated with increased mortality compared with VSE bacteremia among cohort studies (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.38-2.35; I2=0%; n=11); the case-control study estimate was similar, but not significant (OR, 1.93; 95% CI, 0.97-3.82). LOS was greater for VRE bacteremia patients than for VSE bacteremia patients (mean difference, 5.01 days; 95% CI, 0.58-9.44]; I2=0%; n=5). CONCLUSIONS Despite the availability of effective VRE therapy, VRE bacteremia remains associated with an increased risk of in-hospital mortality and LOS when compared to VSE bacteremia. Infect. Control Hosp. Epidemiol. 2015;37(1):26-35. PMID:26434609

  20. State of the Art in Hadron Therapy

    SciTech Connect

    Jaekel, Oliver

    2007-11-26

    Charged particle beams offer an improved dose conformation to the target volume as compared to photon radiotherapy, with better sparing of normal tissue structures close to the target. In addition, beams of ions heavier than helium exhibit a strong increase of the Linear Energy Transfer (LET) in the Bragg peak as compared to the entrance region. These physical and biological properties make ion beams more favorable for radiation therapy of cancer than photon beams. As a consequence, particle therapy with protons and heavy ions has gained increasing interest worldwide. This contribution summarizes the physical and biological principles of charged particle therapy with ion beams and highlights some of the developments in the field of beam delivery, the principles of treatment planning and the determination of absorbed dose in ion beams. The clinical experience gathered so far with carbon ion therapy is briefly reviewed.

  1. Combining radiation therapy and androgen deprivation for localized prostate cancer—a critical review

    PubMed Central

    Dal Pra, A.; Cury, F.L.; Souhami, L.

    2010-01-01

    Interest has been increasing in the use of androgen deprivation therapy (adt) combined with radiation therapy (rt) in the management of localized prostate cancer. Preclinical studies have provided some rationale for the use of this combination. In patients with high-risk disease, the benefit of a combined approach, with the addition of adjuvant hormonal therapy, is supported by results of randomized trials. In contrast, for patients with low-risk disease, there is no obvious therapeutic advantage except for cytoreduction. The usefulness of short-term hormonal therapy in association with rt for intermediate-risk patients is still debatable, particularly in the context of dose-escalated rt. The optimal timing and duration of adt, in the neoadjuvant and adjuvant settings alike, are still under investigation. In view of the potential side effects with adt, further studies are being performed to better identify subsets of patients who will definitely benefit from this therapy in combination with rt. PMID:20975876

  2. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet rich plasma

    PubMed Central

    Best, Thomas M.; Zgierska, Aleksandra E.; Zeisig, Eva; Ryan, Michael; Crane, David

    2009-01-01

    Objective To appraise existing evidence for prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injection therapies for lateral epicondylosis (LE) Design Systematic Review Data sources Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine. Search strategy: names and descriptors of the therapies and LE. Study Selection All human studies assessing the four therapies for LE. Main results Results of five prospective case series and four controlled trials (3 prolotherapy, 2 polidocanol, 3 autologous whole blood and 1 platelet-rich plasma) suggest each of the four therapies is effective for LE. In follow-up periods ranging from 9 to 108 weeks, studies reported sustained, statistically significant(p<0.05) improvement on visual analog scale primary outcome pain score measures and disease specific questionnaires; relative effect sizes ranged from 51% to 94%; Cohen’s d ranged from 0.68 to 6.68. Secondary outcomes also improved, including biomechanical elbow function assessment (polidocanol and prolotherapy), presence of abnormalities and increased vascularity on ultrasound (autologous whole blood and polidocanol). Subjects reported satisfaction with therapies on single-item assessments. All studies were limited by small sample size. Conclusions There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE. Rigorous studies of sufficient sample size, assessing these injection therapies using validated clinical, radiological and biomechanical measures, and tissue injury/healing-responsive biomarkers, are needed to determine long-term effectiveness and safety, and whether these techniques can play a definitive role in the management of LE and other tendinopathies. PMID:19028733

  3. Integrated lab-on-chip biosensing systems based on magnetic particle actuation--a comprehensive review.

    PubMed

    van Reenen, Alexander; de Jong, Arthur M; den Toonder, Jaap M J; Prins, Menno W J

    2014-06-21

    The demand for easy to use and cost effective medical technologies inspires scientists to develop innovative lab-on-chip technologies for point-of-care in vitro diagnostic testing. To fulfill medical needs, the tests should be rapid, sensitive, quantitative, and miniaturizable, and need to integrate all steps from sample-in to result-out. Here, we review the use of magnetic particles actuated by magnetic fields to perform the different process steps that are required for integrated lab-on-chip diagnostic assays. We discuss the use of magnetic particles to mix fluids, to capture specific analytes, to concentrate analytes, to transfer analytes from one solution to another, to label analytes, to perform stringency and washing steps, and to probe biophysical properties of the analytes, distinguishing methodologies with fluid flow and without fluid flow (stationary microfluidics). Our review focuses on efforts to combine and integrate different magnetically actuated assay steps, with the vision that it will become possible in the future to realize integrated lab-on-chip biosensing assays in which all assay process steps are controlled and optimized by magnetic forces. PMID:24806093

  4. Occupational therapy interventions to improve leisure and social participation for older adults with low vision: a systematic review.

    PubMed

    Berger, Sue; McAteer, Jessica; Schreier, Kara; Kaldenberg, Jennifer

    2013-01-01

    This systematic review examined evidence regarding the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in leisure and social participation for older adults with low vision. We identified and reviewed 13 articles that met the inclusion criteria. Four themes related to interventions to improve leisure and social participation emerged from the literature review: using a problem-solving approach, delivering a combination of services, providing skills training, and making home visits and environmental adaptations. The strongest evidence supports using a problem-solving approach to improve leisure and social participation for older adults with low vision. Evidence was moderate supporting the delivery of a combination of services, either by one professional or through an interdisciplinary approach. Results for the effectiveness of skills training and home visits and home adaptations were mixed. Implications for practice, education, and research are discussed. PMID:23597688

  5. Occupational therapy interventions to promote driving and community mobility for older adults with low vision: a systematic review.

    PubMed

    Justiss, Michael D

    2013-01-01

    A systematic literature review was conducted to evaluate the effectiveness of interventions within the scope of occupational therapy practice to improve or maintain the driving performance and community mobility of older adults with low vision. The results of this review identified a limited number of articles-eight-that met the inclusion criteria. Identified intervention strategies included the use of bioptics or prisms, multidisciplinary vision rehabilitation for community mobility, driving simulator training, driver education programs, and orientation and mobility training. Evidence is insufficient for the effectiveness of these interventions in improving or maintaining the driving performance or community mobility of older adults with low vision. Key study limitations included heterogeneity of sample characteristics (age, type of vision impairment), lack of standardization of interventions (device type, time, intensity duration), and lack of standardized assessments to measure driving and community mobility. This evidence-based review is informative for discussion of practice, education, and research implications. PMID:23597687

  6. A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: An update.

    PubMed

    Vera-Garcia, Elisa; Mayoral-Cleries, Fermín; Vancampfort, Davy; Stubbs, Brendon; Cuesta-Vargas, Antonio I

    2015-10-30

    This systematic review summarizes the most recent evidence from randomized controlled trials (RCTs) considering the effectiveness of physical therapy interventions (aerobic exercises, strength exercises, relaxation training, basic body awareness exercises, or a combination of these) within the multidisciplinary management of schizophrenia. Two authors searched PubMed, PsycINFO, EMBASE, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cochrane Library considering RCTs published from July 1, 2011-October 1, 2014. Thirteen RCTs representing 549 participants met the inclusion criteria. Overall, the results demonstrate that aerobic exercise significantly reduces psychiatric symptoms, potentially improves mental and physical quality of life and reduces metabolic risk and weight. Specifically, yoga reduces psychiatric symptoms, whilst Tai-chi and progressive muscle relaxation may also have benefits to patients. Two RCTs reported on adverse events. No adverse event was observed supporting the notion that physical therapy is safe in people with schizophrenia. There was considerable heterogeneity in the design, implementation and outcomes in the included studies precluding a meaningful meta-analysis. In general, the quality of physical therapy RCTS is improving and current research demonstrates that physical therapy approaches are valuable interventions and can help improve the psychiatric, physical and quality of life of people with schizophrenia. PMID:26254795

  7. Analysis of laser therapy and assessment methods in the rehabilitation of temporomandibular disorder: a systematic review of the literature

    PubMed Central

    Herpich, Carolina Marciela; Amaral, Ana Paula; Leal-Junior, Ernesto Cesar Pinto; Tosato, Juliana de Paiva; Gomes, Cid Andre Fidelis de Paula; Arruda, Éric Edmur Camargo; Glória, Igor Phillip dos Santos; Garcia, Marilia Barbosa Santos; Barbosa, Bruno Roberto Borges; Rodrigues, Monique Sampaio; Silva, Katiane Lima; El Hage, Yasmin; Politti, Fabiano; Gonzalez, Tabajara de Oliveira; Bussadori, Sandra Kalil; Biasotto-Gonzalez, Daniela Aparecida

    2015-01-01

    The aim of the present study was to perform a systematic review of the literature on the effects of low-level laser therapy in the treatment of TMD, and to analyze the use of different assessment tools. [Subjects and Methods] Searches were carried out of the BIREME, MEDLINE, PubMed and SciELO electronic databases by two independent researchers for papers published in English and Portuguese using the terms: “temporomandibular joint laser therapy” and “TMJ laser treatment”. [Results] Following the application of the eligibility criteria, 11 papers were selected for in-depth analysis. The papers analyzed exhibited considerable methodological differences, especially with regard to the number of sessions, anatomic site and duration of low-level laser therapy irradiation, as well as irradiation parameters, diagnostic criteria and assessment tools. [Conclusion] Further studies are needed, especially randomized clinical trials, to establish the exact dose and ideal parameters for low-level laser therapy and define the best assessment tools in this promising field of research that may benefit individuals with signs and symptoms of TMD. PMID:25642095

  8. A review of microfabrication techniques and dielectrophoretic microdevices for particle manipulation and separation

    NASA Astrophysics Data System (ADS)

    Li, M.; Li, W. H.; Zhang, J.; Alici, G.; Wen, W.

    2014-02-01

    The development of lab-on-a-chip (LOC) devices over the past decade has attracted growing interest. LOC devices aim to achieve the miniaturization, integration, automation and parallelization of biological and chemical assays. One of the applications, the ability to effectively and accurately manipulate and separate micro- and nano-scale particles in an aqueous solution, is particularly appealing in biological, chemical and medical fields. Among the technologies that have been developed and implemented in microfluidic microsystems for particle manipulation and separation (such as mechanical, inertial, hydrodynamic, acoustic, optical, magnetic and electrical methodologies), dielectrophoresis (DEP) may prove to be the most popular because of its label-free nature, ability to manipulate neutral bioparticles, analyse with high selectivity and sensitivity, compatibility with LOC devices, and easy and direct interface with electronics. The required spatial electric non-uniformities for the DEP effect can be generated by patterning microelectrode arrays within microchannels, or placing insulating obstacles within a microchannel and curving the microchannels. A wide variety of electrode- and insulator-based DEP microdevices have been developed, fabricated, and successfully employed to manipulate and separate bioparticles (i.e. DNA, proteins, bacteria, viruses, mammalian and yeast cells). This review provides an overview of the state-of-the-art of microfabrication techniques and of the structures of dielectrophoretic microdevices aimed towards different applications. The techniques used for particle manipulation and separation based on microfluidics are provided in this paper. In addition, we also present the theoretical background of DEP.

  9. Testosterone therapy in men with prostate cancer: literature review, clinical experience, and recommendations

    PubMed Central

    Morgentaler, Abraham; Conners III, William P

    2015-01-01

    For several decades any diagnosis of prostate cancer (PCa) has been considered an absolute contraindication to the use of testosterone (T) therapy in men. Yet this prohibition against T therapy has undergone recent re-examination with refinement of our understanding of the biology of androgens and PCa, and increased appreciation of the benefits of T therapy. A reassuringly low rate of negative outcomes has been reported with T therapy after radical prostatectomy (RP), radiation treatments, and in men on active surveillance. Although the number of these published reports are few and the total number of treated men is low, these experiences do provide a basis for consideration of T therapy in selected men with PCa. For clinicians considering offering this treatment, we recommend first selecting patients with low grade cancers and undetectable prostate-specific antigen following RP. Further research is required to define the safety of T therapy in men with PCa. However, many patients symptomatic from T deficiency are willing to accept the potential risk of PCa progression or recurrence in return for the opportunity to live a fuller and happier life with T therapy. PMID:25652633

  10. Testosterone therapy in men with prostate cancer: literature review, clinical experience, and recommendations.

    PubMed

    Morgentaler, Abraham; Conners, William P

    2015-01-01

    For several decades any diagnosis of prostate cancer (PCa) has been considered an absolute contraindication to the use of testosterone (T) therapy in men. Yet this prohibition against T therapy has undergone recent re-examination with refinement of our understanding of the biology of androgens and PCa, and increased appreciation of the benefits of T therapy. A reassuringly low rate of negative outcomes has been reported with T therapy after radical prostatectomy (RP), radiation treatments, and in men on active surveillance. Although the number of these published reports are few and the total number of treated men is low, these experiences do provide a basis for consideration of T therapy in selected men with PCa. For clinicians considering offering this treatment, we recommend first selecting patients with low grade cancers and undetectable prostate-specific antigen following RP. Further research is required to define the safety of T therapy in men with PCa. However, many patients symptomatic from T deficiency are willing to accept the potential risk of PCa progression or recurrence in return for the opportunity to live a fuller and happier life with T therapy. PMID:25652633

  11. Effect of Directly Observed Therapy for Highly Active Antiretroviral Therapy on Virologic, Immunologic, and Adherence Outcomes: A Meta-Analysis and Systematic Review

    PubMed Central

    Hart, Jessica E.; Jeon, Christie Y.; Ivers, Louise C.; Behforouz, Heidi L.; Caldas, Adolfo; Drobac, Peter C.; Shin, Sonya S.

    2013-01-01

    Introduction Directly observed therapy of highly active antiretroviral therapy (DOT-HAART) is a feasible adherence intervention. Prospective DOT-HAART studies have shown mixed results, and optimal target groups have yet to be defined. We performed a meta-analysis and systematic review to assess the effect of DOT-HAART on adherence and virologic and immunologic response. Methods We performed a comprehensive search through August 2009 to identify peer-reviewed controlled studies that involved outpatient DOT-HAART among adults and reported at least 1 outcome assessed in this meta-analysis. Random-effects meta-analyses were performed; differences in effect on virologic suppression were examined using stratified meta-analyses and meta-regression on several study characteristics. Results Seventeen studies met inclusion criteria. Compared with control groups, DOT-HAART recipients were more likely to achieve an undetectable viral load (random effects risk ratio 1.24, 95% confidence interval (CI): 1.08 to 1.41), a greater increase in CD4 cell count (random effects weighted mean difference 43 cells/?L, 95% CI: 12 to 74 cells/?L), and HAART adherence of ?95% (random effects risk ratio 1.17, 95% CI: 1.03 to 1.32). Results varied with respect to virologic response. DOT-HAART did not have a significant effect on virologic suppression when restricted to randomized controlled studies. Post-treatment effect was not observed in a limited number of studies. Conclusions DOT-HAART had a significant effect on virologic, immunologic, and adherence outcomes, although its efficacy was not supported when restricting analysis to randomized controlled trials. DOT-HAART shows greatest treatment effect when targeting individuals with greater risk of nonadherence and when delivering the intervention that maximizes participant convenience and provides enhanced adherence support. Further investigation is needed to assess the postintervention effect and cost-effectiveness of DOT-HAART. PMID:20375848

  12. The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments.

    PubMed

    Thase, Michael E; Kingdon, David; Turkington, Douglas

    2014-10-01

    Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state-of-the-art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research. PMID:25273290

  13. Nothing but NET: A review of norepinephrine transporter expression and efficacy of 131I-mIBG therapy

    PubMed Central

    Streby, Keri A; Shah, Nilay; Ranalli, Mark A; Kunkler, Anne; Cripe, Timothy P

    2015-01-01

    Neuroblastoma is unique amongst common pediatric cancers for its expression of the norepinephrine transporter (NET), enabling tumor-selective imaging and therapy with radioactive analogues of norepinephrine. The majority of neuroblastoma tumors are avid for 123I-metaiodobenzaguanidine (mIBG) on imaging, yet the therapeutic response to 131I-mIBG is only 30% in clinical trials, and off-target effects cause short- and long-term morbidity. We review the contemporary understanding of the tumor-selective uptake, retention, and efflux of meta-iodobenzylguanidine (mIBG) and strategies currently in development for improving its efficacy. Combination treatment strategies aimed at enhancing NET are likely necessary to reach the full potential of 131I-mIBG therapy. PMID:25175627

  14. A Review of Gene Delivery and Stem Cell Based Therapies for Regenerating Inner Ear Hair Cells

    E-print Network

    Devarajan, Keerthana; Staecker, Hinrich; Detamore, Michael

    2011-01-01

    Sensory neural hearing loss and vestibular dysfunction have become the most common forms of sensory defects, affecting millions of people worldwide. Developing effective therapies to restore hearing loss is challenging, owing to the limited...

  15. A Review of Gene Delivery and Stem Cell Based Therapies for Regenerating Inner Ear Hair Cells

    E-print Network

    Devarajan, Keerthana; Staecker, Hinrich; Detamore, Michael S.

    2011-09-13

    Sensory neural hearing loss and vestibular dysfunction have become the most common forms of sensory defects, affecting millions of people worldwide. Developing effective therapies to restore hearing loss is challenging, owing to the limited...

  16. Therapies for Treatment-Resistant Depression: A Review of the Research

    MedlinePLUS

    ... report at www.effectivehealthcare.ahrq.gov/trd.cfm . Understanding My Condition Why isn’t the medicine working? ... switching to one or more non-medicine therapies. Understanding My Options What are non-medicine treatments? Although ...

  17. Antithrombotic therapy for patients with nonvalvular atrial fibrillation undergoing percutaneous coronary intervention: a review.

    PubMed

    Krasner, Andrew; Halperin, Jonathan L

    2013-07-01

    Patients with atrial fibrillation who have risk factors for thromboembolism benefit from chronic oral anticoagulation therapy, and antiplatelet therapy alone is of relatively little benefit for prevention of ischemic stroke and systemic embolism. Patients undergoing percutaneous coronary intervention with drug-eluting stents require dual antiplatelet therapy with aspirin and a thienopyridine for 3 to 12 months or more prevention of stent thrombosis and recurrent ischemic events. When patients with atrial fibrillation undergo percutaneous coronary intervention, the need to combine dual antiplatelet therapy and warfarin raises the risk of major bleeding complications considerably. Recent trials have explored the option of omitting aspirin with promising results. The introduction of novel oral anticoagulants that specifically inhibit factor IIa (dabigatran) or factor Xa (rivaroxaban, apixaban, and edoxaban) and antiplatelet agents that inhibit the P(2)Y(12) receptor (prasugrel and ticagrelor) makes management of these patients even more challenging, but future trials addressing myriad alternative regimens may identify better tolerated strategies. PMID:23689944

  18. [Design and study of parallel computing environment of Monte Carlo simulation for particle therapy planning using a public cloud-computing infrastructure].

    PubMed

    Yokohama, Noriya

    2013-07-01

    This report was aimed at structuring the design of architectures and studying performance measurement of a parallel computing environment using a Monte Carlo simulation for particle therapy using a high performance computing (HPC) instance within a public cloud-computing infrastructure. Performance measurements showed an approximately 28 times faster speed than seen with single-thread architecture, combined with improved stability. A study of methods of optimizing the system operations also indicated lower cost. PMID:23877155

  19. Use of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Hospital: A Review of One Institution's Experience

    PubMed Central

    Leonhardi, Brenda J.; Boyle, Mary E.; Beer, Karen A.; Seifert, Karen M.; Bailey, Marilyn; Miller-Cage, Victoria; Castro, Janna C.; Bourgeois, Peggy B.; Cook, Curtiss B.

    2008-01-01

    Background This article reviews the performance of our hospital's inpatient insulin pump policy. Methods Twenty-five hospital admissions of 21 unique patients receiving outpatient insulin pump therapy were reviewed. Results Between November 1, 2005, and November 30, 2006, there were 25 hospital admissions involving 21 patients receiving outpatient insulin pump therapy. The average age and duration of diabetes among these 21 patients was 50 and 29 years, respectively; 67% were women, 90% had type 1 diabetes, and all were white. The mean length of hospital stay was 4 days, and the average reported length of insulin pump therapy was 4 years. Patients in 16 of the admissions were identified as candidates for continued use of the insulin pump during the hospital stay. Over 90% of patients remaining on the insulin pump had documentation by nursing of the presence of the pump at the time of admission; 100% of the patients had an admission glucose recorded; 88% had a record of signed patient consent; 81% had evidence of completed preprinted insulin pump orders; 75% received a required endocrine consultation; and 75% of cases had documentation of completed bedside flow sheet. A high frequency of both hypoglycemic and hyperglycemic events occurred in the patients; however, no adverse events were related directly to the insulin pump. Conclusions Insulin pump therapy can be safely continued in the hospital setting. While staff compliance with required procedures was high, there was still room for improvement. More data are needed, however, on whether this method of insulin delivery is effective for controlling hyperglycemia in hospitalized patients. PMID:19885284

  20. Meditative Movement Therapies and Health-Related Quality-of-Life in Adults: A Systematic Review of Meta-Analyses

    PubMed Central

    2015-01-01

    Poor health-related quality-of-life (HRQOL) is a significant public health issue while the use of meditative movement therapies has been increasing. The purpose of this investigation was to carry out a systematic review of previous meta-analyses that examined the effects of meditative movement therapies (yoga, tai chi and qigong) on HRQOL in adults. Previous meta-analyses of randomized controlled trials published up through February, 2014 were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction occurred. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality. Standardized mean differences that were pooled using random-effects models were included. In addition, 95% prediction intervals were calculated as well as the number needed-to-treat and percentile improvements. Of the 510 citations screened, 10 meta-analyses representing a median of 3 standardized mean differences in 82 to 528 participants (median = 270) with breast cancer, schizophrenia, low back pain, heart failure and diabetes, were included. Median methodological quality was 70%. Median length, frequency and duration of the meditative movement therapies were 12 weeks, 3 times per week, for 71 minutes per session. The majority of results (78.9%) favored statistically significant improvements (non-overlapping 95% confidence intervals) in HRQOL, with standardized mean differences ranging from 0.18 to 2.28. More than half of the results yielded statistically significant heterogeneity (Q ? 0.10) and large or very large inconsistency (I2 ? 50%). All 95% prediction intervals included zero. The number-needed-to-treat ranged from 2 to 10 while percentile improvements ranged from 9.9 to 48.9. The results of this study suggest that meditative movement therapies may improve HRQOL in adults with selected conditions. However, a need exists for a large, more inclusive meta-analysis (PROSPERO Registration #CRD42014014576). PMID:26053053

  1. Meditative Movement Therapies and Health-Related Quality-of-Life in Adults: A Systematic Review of Meta-Analyses.

    PubMed

    Kelley, George A; Kelley, Kristi S

    2015-01-01

    Poor health-related quality-of-life (HRQOL) is a significant public health issue while the use of meditative movement therapies has been increasing. The purpose of this investigation was to carry out a systematic review of previous meta-analyses that examined the effects of meditative movement therapies (yoga, tai chi and qigong) on HRQOL in adults. Previous meta-analyses of randomized controlled trials published up through February, 2014 were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction occurred. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality. Standardized mean differences that were pooled using random-effects models were included. In addition, 95% prediction intervals were calculated as well as the number needed-to-treat and percentile improvements. Of the 510 citations screened, 10 meta-analyses representing a median of 3 standardized mean differences in 82 to 528 participants (median = 270) with breast cancer, schizophrenia, low back pain, heart failure and diabetes, were included. Median methodological quality was 70%. Median length, frequency and duration of the meditative movement therapies were 12 weeks, 3 times per week, for 71 minutes per session. The majority of results (78.9%) favored statistically significant improvements (non-overlapping 95% confidence intervals) in HRQOL, with standardized mean differences ranging from 0.18 to 2.28. More than half of the results yielded statistically significant heterogeneity (Q ? 0.10) and large or very large inconsistency (I2 ? 50%). All 95% prediction intervals included zero. The number-needed-to-treat ranged from 2 to 10 while percentile improvements ranged from 9.9 to 48.9. The results of this study suggest that meditative movement therapies may improve HRQOL in adults with selected conditions. However, a need exists for a large, more inclusive meta-analysis (PROSPERO Registration #CRD42014014576). PMID:26053053

  2. [Current situation and perspectives of proton therapy].

    PubMed

    Doyen, J; Bondiau, P-Y; Bénézéry, K; Chand, M-È; Thariat, J; Leysalle, A; Gérard, J-P; Habrand, J-L; Hannoun-Lévi, J-M

    2015-05-01

    Proton beam therapy is indicated as a treatment for some rare tumours and paediatric tumours because the technique allows a good local control with minimal toxicity; the growing number of centres that use proton beam therapy is associated with an increase of dosimetric and clinical data for other malignant tumours as well. This paper reviews potential indications of proton beam therapy. A systematic review on Medline was performed with the following keywords proton beam therapy, cancer, heavy particle, charged particle. No phase III trial has been published using proton beam therapy in comparison with the best photon therapy, but numerous retrospective and dosimetric studies have revealed an advantage of proton beam therapy compared to photons, above all in tumours next to parallel organs at risk (thoracic and abdominal tumours). This could be accompanied with a better safety profile and/or a better tumoural control; numerous phase 0, I, II, III and IV studies are ongoing to examine these hypotheses in more common cancers. Use of proton beam therapy is growing for common cancers within clinical trials but some indications could be applied sooner since in silico analysis showed major advantages with this technique. PMID:25840776

  3. Zoledronic Acid as an Adjuvant Therapy in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

    PubMed Central

    Huang, Wei-Wei; Huang, Cheng; Liu, Jian; Zheng, Hong-Yu; Lin, Lin

    2012-01-01

    Background Zoledronic acid is widely used as adjuvant chemotherapy for the treatment of breast cancer. However, previous trials reported inconsistent findings regarding their clinical efficacy and safety. We carried out a comprehensive systematic review and meta-analysis to evaluate the effects of zoledronic acid on disease-free survival (DFS), overall survival (OS), and drug-related toxicities. Methodology and Principal Findings We systematically searched Medline, EmBase, the Cochrane Central Register of Controlled Trials, reference lists of articles and proceedings of major meetings for relevant literatures with a time limit of Dec. 1, 2011. Randomized controlled trials evaluated the effects of zoledronic acid on OS, DFS, and RFS compared with control were eligible for inclusion in our research. Of 175 identified studies, we collected data from 7 randomized controlled trials of zoledronic acid that had OS, DFS, and RFS reported as one of the endpoint. Overall, we noted that patients receiving zoledronic acid therapy had significant longer OS than the group with non-zoledronic acid therapy (HR, 0.85, 95%CI, 0.73 to 1.00, P?=?0.047). Furthermore, zoledronic acid therapy also had a clear effect on frature events (RR, 0.66, 95%CI, 0.52 to 0.84, P<0.001). Subgroup analysis indicated that zoledronic acid therapy showed a great beneficial effect on disease recurrence in patients with early-stage breast cancer, however, it also significantly increased the harm of disease recurrence in patients with advanced breast cancer. Bone pain, neutropenic fever, pyrexia, rash were more frequent in the zoledronic acid therapy group. Conclusion/Significance Treatment with zoledronic acid had a clear effect on fracture events, and it might contribute an important role for overall survival. PMID:22844410

  4. Ultrasound Assessment of Carotid Plaque Echogenicity Response to Statin Therapy: A Systematic Review and Meta-Analysis

    PubMed Central

    Ibrahimi, Pranvera; Jashari, Fisnik; Bajraktari, Gani; Wester, Per; Henein, Michael Y.

    2015-01-01

    Objective: To evaluate in a systematic review and meta-analysis model the effect of statin therapy on carotid plaque echogenicity assessed by ultrasound. Methods: We have systematically searched electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to April, 2015, for studies evaluating the effect of statins on plaque echogenicity. Two researchers independently determined the eligibility of studies evaluating the effect of statin therapy on carotid plaque echogenicity that used ultrasound and grey scale median (GSM) or integrated back scatter (IBS). Results: Nine out of 580 identified studies including 566 patients’ carotid artery data were meta-analyzed for a mean follow up of 7.2 months. A consistent increase in the echogenicity of carotid artery plaques, after statin therapy, was reported. Pooled weighted mean difference % (WMD) on plaque echogenicity after statin therapy was 29% (95% CI 22%–36%), p < 0.001, I2 = 92.1%. In a meta-regression analysis using % mean changes of LDL, HDL and hsCRP as moderators, it was shown that the effects of statins on plaque echogenicity were related to changes in hsCRP, but not to LDL and HDL changes from the baseline. The effect of statins on the plaque was progressive; it showed significance after the first month of treatment, and the echogenicity continued to increase in the following six and 12 months. Conclusions: Statin therapy is associated with a favorable increase of carotid plaque echogenicity. This effect seems to be dependent on the period of treatment and hsCRP change from the baseline, independent of changes in LDL and HDL. PMID:25984600

  5. The use of low level laser therapy in the treatment of temporomandibular joint disorders. Review of the literature

    PubMed Central

    Herranz-Aparicio, Judit; Vázquez-Delgado, Eduardo; Arnabat-Domínguez, Josep; España-Tost, Antoni

    2013-01-01

    Introduction: The temporomandibular disorders (TMDs) have been identified as the most important cause of pain in the facial region. The low level laser therapy (LLLT) has demonstrated to have an analgesic, anti-inflammatory and biostimulating effects. The LLLT is a noninvasive, quick and safe, non-pharmaceutical intervention that may be beneficial for patients with TMDs. However the clinical efficiency of LLLT in the treatment of this kind of disorders is controversial. Objectives: Literature review in reference to the use of LLLT in the treatment of TMDs, considering the scientific evidence level of the published studies. Material and Methods: A MEDLINE and COCHRANE database search was made for articles. The keywords used were “temporomandibular disorders” and “low level laser therapy” or “phototherapy” and by means of the Boolean operator “AND”. The search provided a bank of 35 articles, and 16 relevant articles were selected to this review. These articles were critically analyzed and classified according to their level of scientific evidence. This analysis produced 3 literature review articles and 13 are clinical trials. The SORT criteria (Strength of Recommendation Taxonomy) was used to classify the articles. Results: Only one article presented an evidence level 1, twelve presented an evidence level 2, and three presented an evidence level 3. According to the principle of evidence-based dentistry, currently there is a scientific evidence level B in favor of using LLLT for treatment of TMDs. Discussion and conclusions: Publications on the use of LLLT for treatment of TMDs are limited making difficult to compare the different studies due to the great variability of the studied variables and the selected laser parameters. The great majority of the studies concluded that the results should be taken with caution due to the methodological limitations. Key words:Low level laser therapy; phototherapy; temporomandibular joint disorders. PMID:23722130

  6. Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy

    PubMed Central

    Amelio, Dante; Winter, Marcus; Habermehl, Daniel; Jäkel, Oliver; Debus, Jurgen; Combs, Stephanie E.

    2013-01-01

    The present paper reports and discusses the results concerning both the inter- and intrafraction accuracy achievable combining the immobilization system employed in patients with head-and-neck, brain and skull base tumors with image guidance at our particle therapy center. Moreover, we investigated the influence of intrafraction time on positioning displacements. A total of 41 patients treated between January and July 2011 represented the study population. All the patients were immobilized with a tailored commercial thermoplastic head mask with standard head-neck rest (HeadSTEP®, IT-V). Patient treatment position was verified by two orthogonal kilovoltage images acquired through a ceiling imaging robot (Siemens, Erlangen, Germany). The analysis of the applied daily corrections during the first treatment week before and after treatment delivery allowed the evaluation of the interfraction and intrafraction reproducibility of the thermoplastic mask, respectively. Concerning interfraction reproducibility, translational and rotational systematic errors (?s) were ?2.2 mm and 0.9º, respectively; translational and rotational random errors (?s) were ?1.6 mm and 0.6º, respectively. Regarding the intrafraction accuracy translational and rotational ?s were ?0.4 mm and 0.4º, respectively; translational and rotational ?s were ? 0.5 mm and 0.3º, respectively. Concerning the time-intrafraction displacements correlation Pearson coefficient was 0.5 for treatment fractions with time between position checks less than or equal to median value, and 0.2 for those with time between position controls longer than the median figure. These results suggest that intrafractional patient motion is smaller than interfractional patient motion. Moreover, we can state that application of different imaging verification protocols translate into a relevant difference of accuracy for the same immobilization device. The magnitude of intrafraction displacements correlates with the time for short treatment sessions or during the early phase of long treatment delivery. PMID:23824130

  7. A review of dispersion modelling and its application to the dispersion of particles: An overview of different dispersion models available

    NASA Astrophysics Data System (ADS)

    Holmes, N. S.; Morawska, L.

    This paper provides the first review of the application of atmospheric models for particle dispersion. The different types of dispersion models available, from simple box type models to complex fluid dynamics models are outlined and the suitability of the different approaches to dispersion modelling within different environments, in regards to scale, complexity of the environment and concentration parameters is assessed. Finally, several major commercial and non-commercial particle dispersion packages are reviewed, detailing which processes are included and advantages and limitations of their use to modelling particle dispersion. The models reviewed included: Box models (AURORA, CPB and PBM), Gaussian models (CALINE4, HIWAY2, CAR-FMI, OSPM, CALPUFF, AEROPOL, AERMOD, UK-ADMS and SCREEN3), Lagrangian/Eulerian Models (GRAL, TAPM, ARIA Regional), CFD models (ARIA Local, MISKAM, MICRO-CALGRID) and models which include aerosol dynamics (GATOR, MONO32, UHMA, CIT, AERO, RPM, AEROFOR2, URM-1ATM, MADRID, CALGRID and UNI-AERO).

  8. Penile traction therapy and Peyronie’s disease: a state of art review of the current literature

    PubMed Central

    Brock, Gerald

    2013-01-01

    In recent years, penile traction therapy (PTT) has gained considerable interest as a novel nonsurgical treatment option for men with Peyronie’s disease (PD) and short penises. The current published literature suggests that selected cases of PD may benefit from a conservative approach with PTT, resulting in increased penile length and reduction of penile deformity. It appears to be safe and well tolerated but requires a great deal of patient compliance and determination. This article reviews the current literature pertaining to the use of PTT in men with PD, short penises and in the setting of pre- and postprosthesis corporal fibrosis. PMID:23372611

  9. Safety and efficacy of therapies for skin symptoms of psoriasis in patients with psoriatic arthritis: a systematic review.

    PubMed

    Boehncke, Wolf-Henning; Alvarez Martinez, David; Solomon, James A; Gottlieb, Alice B

    2014-11-01

    Numerous guidelines and recommendations exist for the treatment of psoriasis in various populations. One important population is patients with psoriatic arthritis (PsA) who have symptoms of both joint and skin disease. In patients with both facets of psoriatic disease, skin and joints must be treated separately, but also simultaneously. As several systemic therapies are approved for either one or both, the concept of treating both facets with the same drug is feasible. This review summarizes evidence from studies in patients with PsA on the efficacy of these drugs on psoriatic skin disease in these patients. PMID:25362715

  10. Systematic Review of the Efficacy of Cognitive-Behavior Therapy Related Treatments for Victims of Natural Disasters: A Worldwide Problem

    PubMed Central

    Lopes, Alessandra Pereira; Macedo, Tânia Fagundes; Coutinho, Evandro Silva Freire; Figueira, Ivan; Ventura, Paula Rui

    2014-01-01

    Natural disasters can have devastating consequences. Each year, about 225 million people are victims of natural disasters worldwide, and up to 13,5 million of these people can develop post-traumatic stress disorder (PTSD) in the first or second year following the disaster. Cognitive-behavior therapy (CBT) is the first-choice treatment for this disorder. In order to evaluate the efficacy of psychotherapeutic treatment based on cognitive-behavior therapy for people who developed post traumatic stress disorder after natural disasters we conducted a systematic search of published studies. We used the terms reported below in the electronic databases ISI Web of Science, PsycINFO, PubMed, PILOTS and Scopus with no restrictions of language or publication date. Articles that described randomized controlled, non-randomized controlled and non controlled studies on the efficacy of cognitive-behavior therapy for individuals diagnosed with post-traumatic stress disorder after exposure to a natural disaster were eligible for inclusion. The studies were required to use a standardized measure of effectiveness before and after the intervention and have a group of patients who had used cognitive-behavior therapy as the only intervention. Our search identified 820 studies, and 11 were selected for this review. These 11 studies involved 742 subjects, 10 related to earthquakes and 1 to a hurricane. The cognitive-behavior therapy techniques used were various: 7 studies used exposure therapy, 2 studies used problem solving, and the only 2 studies with adolescents used techniques including reconstructions and reprocessing of the traumatic experience. As limitations, the search involved only five electronic databases, no experts in the field were consulted, and the heterogeneity of the findings made it impossible to perform a meta-analysis. The results suggest the efficacy of cognitive-behavior therapy, particularly exposure techniques, for the treatment of post-traumatic stress disorder after earthquakes. However, further studies with stronger methodologies, i.e. randomized-control trials and non-randomized controlled trials, are needed. PMID:25296020

  11. TOPICAL REVIEW: Low-dimensional surface oxides in the oxidation of Rh particles

    NASA Astrophysics Data System (ADS)

    Mittendorfer, Florian

    2010-10-01

    The oxidation of rhodium particles leads to the formation of low-dimensional nanostructures, namely ultrathin oxide films and stripes adsorbed on the metallic surface. These structures display unique electronic and structural properties, which have been studied in detail experimentally and theoretically in recent years. In this review, the state of research on low-dimensional surface oxides formed on Rh surfaces will be discussed with a special focus on the contributions derived from computational approaches. Several points elucidating the novel properties of the surface oxides will be addressed: (i) the structural relation between the surface oxides and their bulk counterparts, (ii) the electronic properties of the low-dimensional oxide films and (iii) potential catalytic and electronic applications of the surface oxides.

  12. Sucrose as a dosimetric material for photon and heavy particle radiation: A review

    NASA Astrophysics Data System (ADS)

    Karakirova, Yordanka; Yordanov, Nicola D.

    2015-05-01

    The application of high-energy radiation in many areas of human activity and its harmful effects on human health makes necessary knowledge of the radiation chemistry of various materials upon exposure to high-energy radiation. Among these materials, saccharides (particularly sucrose) maintain the greatest advantage for potential radiochemistry applications. Until now, radiation chemistry studies have been conducted primarily with ?-ray irradiation; however, in the past few years there has been increased interest in the fields of radiotherapy and radiochemistry on substances irradiated with heavy particles. To this end, this review discusses the possibilities of employing sucrose as a radiation-sensitive material for the determination of absorbed doses of high-energy radiation both for emergency situations and for dosimeters used in standard applications.

  13. Probiotics in Helicobacter pylori eradication therapy: A systematic review and meta-analysis

    PubMed Central

    Zhang, Min-Min; Qian, Wei; Qin, Ying-Yi; He, Jia; Zhou, Yu-Hao

    2015-01-01

    AIM: To summarize the evidence from randomized controlled trials (RCTs) regarding the effect of probiotics by using a meta-analytic approach. METHODS: In July 2013, we searched PubMed, EMBASE, Ovid, the Cochrane Library, and three Chinese databases (Chinese Biomedical Literature Database, Chinese Medical Current Content, and Chinese Scientific Journals database) to identify relevant RCTs. We included RCTs investigating the effect of a combination of probiotics and standard therapy (probiotics group) with standard therapy alone (control group). Risk ratios (RRs) were used to measure the effect of probiotics plus standard therapy on Helicobacter pylori (H. pylori) eradication rates, adverse events, and patient compliance using a random-effect model. RESULTS: We included data on 6997 participants from 45 RCTs, the overall eradication rates of the probiotic group and the control group were 82.31% and 72.08%, respectively. We noted that the use of probiotics plus standard therapy was associated with an increased eradication rate by per-protocol set analysis (RR = 1.11; 95%CI: 1.08-1.15; P < 0.001) or intention-to-treat analysis (RR = 1.13; 95%CI: 1.10-1.16; P < 0.001). Furthermore, the incidence of adverse events was 21.44% in the probiotics group and 36.27% in the control group, and it was found that the probiotics plus standard therapy significantly reduced the risk of adverse events (RR = 0.59; 95%CI: 0.48-0.71; P < 0.001), which demonstrated a favorable effect of probiotics in reducing adverse events associated with H. pylori eradication therapy. The specific reduction in adverse events ranged from 30% to 59%, and this reduction was statistically significant. Finally, probiotics plus standard therapy had little or no effect on patient compliance (RR = 0.98; 95%CI: 0.68-1.39; P = 0.889). CONCLUSION: The use of probiotics plus standard therapy was associated with an increase in the H. pylori eradication rate, and a reduction in adverse events resulting from treatment in the general population. However, this therapy did not improve patient compliance. PMID:25892886

  14. Review of dynamic contrast-enhanced ultrasound guidance in ablation therapy for hepatocellular carcinoma

    PubMed Central

    Minami, Yasunori; Kudo, Masatoshi

    2011-01-01

    Local ablative techniques-percutaneous ethanol injection, microwave coagulation therapy and radiofrequency ablation (RFA)-have been developed to treat unresectable hepatocellular carcinoma (HCC). The success rate of percutaneous ablation therapy for HCC depends on correct targeting of the tumor via an imaging technique. However, probe insertion often is not completely accurate for small HCC nodules, which are poorly defined on conventional B-mode ultrasound (US) alone. Thus, multiple sessions of ablation therapy are frequently required in difficult cases. By means of two breakthroughs in US technology, harmonic imaging and the development of second-generation contrast agents, dynamic contrast-enhanced harmonic US imaging with an intravenous contrast agent can depict tumor vascularity sensitively and accurately, and is able to evaluate small hypervascular HCCs even when B-mode US cannot adequately characterize the tumors. Therefore, dynamic contrast-enhanced US can facilitate RFA electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of dynamic contrast-enhanced US guidance in ablation therapy for liver cancer is an efficient approach. Here, we present an overview of the current status of dynamic contrast-enhanced US-guided ablation therapy, and summarize the current indications and outcomes of reported clinical use in comparison with that of other modalities. PMID:22174544

  15. The health significance of gas- and particle-phase terpene oxidation products: a review.

    PubMed

    Rohr, Annette C

    2013-10-01

    The reactions between terpenes and ozone (or other oxidants) produce a wide variety of both gas- and particle-phase products. Terpenes are biogenic volatile organic compounds (VOCs) that are also contained in many consumer products. Ozone is present indoors since it infiltrates into the indoor environment and is emitted by some office and consumer equipment. Some of the gaseous products formed are irritating to biological tissues, while the condensed-phase products have received attention due to their contribution to ambient fine particulate matter (PM2.5) and its respective health significance. Despite common scientific questions, the indoor and ambient air research communities have tended to operate in isolation regarding this topic. This review critically evaluates the literature related to terpene oxidation products and attempts to synthesize results of indoor and ambient air studies to better understand the health significance of these materials and identify knowledge gaps. The review documents the results of a literature search covering terpene oxidation chemistry, epidemiological, toxicological, and controlled human exposure studies, as well as health studies focused more generically on secondary organic aerosol (SOA). The literature shows a clear role for gas-phase terpene oxidation products in adverse airway effects at high concentrations; however, whether these effects occur at more environmentally relevant levels is unclear. The evidence for toxicity of particle-phase products is less conclusive. Knowledge gaps and future research needs are outlined, and include the need for more consistency in study designs, incorporation of reaction product measurements into epidemiological studies conducted in both indoor and ambient settings, and more focused research on the toxicity of SOA, especially SOA of biogenic origin. PMID:24036325

  16. Particle deposition from turbulent flow: Review of published research and its applicability to ventilation ducts in commercial buildings

    SciTech Connect

    Sippola, Mark R.; Nazaroff, William W.

    2002-06-01

    This report reviews published experimental and theoretical investigations of particle deposition from turbulent flows and considers the applicability of this body of work to the specific case of particle deposition from flows in the ducts of heating, ventilating and air conditioning (HVAC) systems. Particle deposition can detrimentally affect the performance of HVAC systems and it influences the exposure of building occupants to a variety of air pollutants. The first section of this report describes the types of HVAC systems under consideration and discusses the components, materials and operating parameters commonly found in these systems. The second section reviews published experimental investigations of particle deposition rates from turbulent flows and considers the ramifications of the experimental evidence with respect to HVAC ducts. The third section considers the structure of turbulent airflows in ventilation ducts with a particular emphasis on turbulence investigations that have been used as a basis for particle deposition models. The final section reviews published literature on predicting particle deposition rates from turbulent flows.

  17. Applications of linac-mounted kilovoltage Cone-beam Computed Tomography in modern radiation therapy: A review

    PubMed Central

    Srinivasan, Kavitha; Mohammadi, Mohammad; Shepherd, Justin

    2014-01-01

    Summary The use of Cone-beam Computed Tomography (CBCT) in radiotherapy is increasing due to the widespread implementation of kilovoltage systems on the currently available linear accelerators. Cone beam CT acts as an effective Image-Guided Radiotherapy (IGRT) tool for the verification of patient position. It also opens up the possibility of real-time re-optimization of treatment plans for Adaptive Radiotherapy (ART). This paper reviews the most prominent applications of CBCT (linac-mounted) in radiation therapy, focusing on CBCT-based planning and dose calculation studies. This is followed by a concise review of the main issues associated with CBCT, such as imaging artifacts, dose and image quality. It explores how medical physicists and oncologists can best apply CBCT for therapeutic applications. PMID:25006356

  18. Hyperbaric Oxygen Therapy—A Novel Treatment Modality in Oral Submucous Fibrosis: A Review

    PubMed Central

    Kumar, M. Ashwini; Radhika, Besta; Reddy, Satya Prakash; Yaga, Uday Shankar

    2015-01-01

    Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by juxta epithelial fibrosis of the oral cavity and regarded as a potentially malignant disorder. Numerous treatment modalities ranging from various drugs to behavioral therapy have been tried with inconsistent results with varying degrees of success reflecting low predictability, requiring further evaluation and standardization. Novel treatment modality such as Hyperbaric oxygen therapy (HBOT) involves inhalation of 100% oxygen at increased atmospheric pressure usually ranging between 2.0 and 2.5 atmospheres for periods between 60 and 120 min. HBOT which can increase oxygen tension and delivery to oxygen-deficient tissue, is a supplementary therapy to improve hypoxic environment of OSMF and also possesses potent anti-inflammatory properties. This article enlightens on possible beneficial effects of HBOT in the management of OSMF at cellular and molecular level. PMID:26155590

  19. A review of commuter exposure to ultrafine particles and its health effects

    NASA Astrophysics Data System (ADS)

    Knibbs, Luke D.; Cole-Hunter, Tom; Morawska, Lidia

    2011-05-01

    Ultrafine particles (UFPs, <100 nm) are produced in large quantities by vehicular combustion and are implicated in causing several adverse human health effects. Recent work has suggested that a large proportion of daily UFP exposure may occur during commuting. However, the determinants, variability and transport mode-dependence of such exposure are not well-understood. The aim of this review was to address these knowledge gaps by distilling the results of 'in-transit' UFP exposure studies performed to-date, including studies of health effects. We identified 47 exposure studies performed across 6 transport modes: automobile, bicycle, bus, ferry, rail and walking. These encompassed approximately 3000 individual trips where UFP concentrations were measured. After weighting mean UFP concentrations by the number of trips in which they were collected, we found overall mean UFP concentrations of 3.4, 4.2, 4.5, 4.7, 4.9 and 5.7 × 10 4 particles cm -3 for the bicycle, bus, automobile, rail, walking and ferry modes, respectively. The mean concentration inside automobiles travelling through tunnels was 3.0 × 10 5 particles cm -3. While the mean concentrations were indicative of general trends, we found that the determinants of exposure (meteorology, traffic parameters, route, fuel type, exhaust treatment technologies, cabin ventilation, filtration, deposition, UFP penetration) exhibited marked variability and mode-dependence, such that it is not necessarily appropriate to rank modes in order of exposure without detailed consideration of these factors. Ten in-transit health effects studies have been conducted and their results indicate that UFP exposure during commuting can elicit acute effects in both healthy and health-compromised individuals. We suggest that future work should focus on further defining the contribution of in-transit UFP exposure to total UFP exposure, exploring its specific health effects and investigating exposures in the developing world.

  20. Androgen-deprivation therapy alone versus combined with radiation therapy or chemotherapy for nonlocalized prostate cancer: a systematic review and meta-analysis.

    PubMed

    Lei, Jun-Hao; Liu, Liang-Ren; Wei, Qiang; Song, Tu-Run; Yang, Lu; Meng, Yang; Han, Ping

    2016-01-01

    In this paper, we reviewed the long-term survival outcomes, safety, and quality-of-life of androgen-deprivation therapy (ADT) alone versus combined with radiation therapy (RT) or chemotherapy for locally advanced and metastatic prostate cancer (PCa). A literature search was performed using OvidSP. Randomized controlled trials (RCTs) that met the following criteria were included: including locally advanced or metastatic PCa, comparing ADT alone versus combined with any treatment method and reporting quantitative data of disease control or survival outcomes. Finally, eight RCTs met the inclusion criteria. Among these, three compared ADT versus ADT plus RT (n = 2344) and one compared ADT versus ADT plus docetaxel-estramustine (n = 413) in locally advanced PCa; two compared ADT versus ADT plus docetaxel (n = 1175) and two compared ADT versus ADT plus estramustine (n = 114) in metastatic PCa. For locally advanced PCa, the addition of RT to long-term ADT can improve the outcomes of survival and tumor control with fully acceptable adverse effects. Specially, the pooled odds ratio (OR) of overall survival (OS) was 1.43 (95% confidence interval 1.20-1.71) when compared ADT plus RT with ADT alone (P < 0.0001). For metastatic hormonally sensitive PCa, the concurrent use of docetaxel plus ADT was effective and safe (pooled OR of OS: 1.29 [1.01-1.65]: P = 0.04). In all, long-term ADT plus RT and long-term ADT plus docetaxel should be considered as proper treatment option in locally advanced and metastatic hormonally sensitive PCa, respectively. The major limitation for the paper was that only eight RCTs were available. PMID:25851657