acupuncture typical costs

acupuncture typical costs
Related Articles

Pleiotropic effects of fenretinide in neuroblastoma cell lines and multicellular tumor spheroids.

Int J Oncol. 2008 May;32(5):1011-9

Authors: Cuperus R, Tytgat GA, Leen R, Brites P, Bras J, Caron HN, Van Kuilenburg AB

The efficacy and mechanism of action of fenretinide (4-HPR), a vitamin A analogue, was investigated in a panel of six neuroblastoma cell lines and multicellular tumor spheroids. The latter are three dimensional cell aggregates and as such, a model for micrometastases. In all cell lines, the production of reactive oxygen species (ROS) increased with 163-680% after 1 h of treatment with 4-HPR. In addition, a decrease of the mitochondrial membrane potential of 30-75% was observed after 4 h of incubation with 4-HPR. A 6-12-fold difference was observed between the IC50 values for cell proliferation and viability between the most sensitive (IMR32) and most resistant (NASS) cell line towards 4-HPR. Flow cytometric analysis showed an increased amount of apoptotic bodies and no cell-cycle arrest. The antioxidant Trolox completely inhibited the accumulation of 4HPR-induced ROS and prevented the 4HPR-associated cytotoxicity. In all neuroblastoma spheroids, 4-HPR induced a complete cytostasis at clinical relevant concentrations (3-10 microM). Immunohistochemical analysis of 4-HPR-treated spheroids showed a decreased staining for proliferation marker Ki-67 and an increased staining for cleaved-PARP, a marker of apoptosis. Our results suggest that 4-HPR might be a promising agent for the treatment of micrometastases and high-risk neuroblastoma.

PMID: 18425327 [PubMed – in process]

(Source: International Journal of Oncology)]></span>
Evaluation of a nanotechnology-based carrier for delivery of curcumin in prostate cancer cells.

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Evaluation of a nanotechnology-based carrier for delivery of curcumin in prostate cancer cells.

Int J Oncol. 2008 May;32(5):1119-23

Authors: Thangapazham RL, Puri A, Tele S, Blumenthal R, Maheshwari RK

We have initiated studies to enhance targeted delivery of an anticancer agent, curcumin, for prostate cancer treatment by incorporating this agent into the liposomes (nanodelivery vehicles primarily composed of phospholipids) coated with prostate membrane specific antigen specific antibodies. We prepared curcumin-loaded liposomes of various lipid compositions by sonication at an average size of 100-150 nm. Un-entrapped curcumin was removed by size exclusion chromatography. Data show that curcumin preferentially partitioned into liposomes prepared from dimyristoyl phosphatidyl choline (DMPC) and cholesterol among the various compositions tested. The anti-proliferative activity of liposomal curcumin was studied using two human prostate cancer cell lines (LNCaP and C4-2B) by a tetrazolium dye-based (MTT) assay. Treatment of cells with liposomal curcumin (5-10 microM) for 24-48 h at 37 degrees C resulted in at least 70-80% inhibition of cellular proliferation without affecting their viability. On the other hand, free curcumin exhibited similar inhibition only at 10-fold higher doses (>50 microM). We also observed that LNCaP cells were relatively more sensitive to liposomal curcumin mediated block of cellular proliferation than C4-2B cells. We are currently developing liposome formulations with targeting ability to further improve the efficacy of curcumin in vivo.

PMID: 18425340 [PubMed – in process]

(Source: International Journal of Oncology)]></span>
Prevention of amyloid beta-induced memory impairment by fluvastatin, associated with the decrease in amyloid beta accumulation and oxidative stressin amyloid beta injection mouse model.

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Prevention of amyloid beta-induced memory impairment by fluvastatin, associated with the decrease in amyloid beta accumulation and oxidative stressin amyloid beta injection mouse model.

Int J Mol Med. 2008 May;21(5):531-7

Authors: Kurinami H, Sato N, Shinohara M, Takeuchi D, Takeda S, Shimamura M, Ogihara T, Morishita R

Alzheimer’s disease (AD), the most common cause of dementia in the elderly, is characterized by amyloid beta (Abeta)-containing plaques and neurofibrillary tangles, and synaptic and neuronal loss, along with progressive cognitive impairment. Although growing evidence suggests the beneficial effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on AD, this notion is still controversial. To evaluate the efficacy of statins for Abeta-induced cognitive impairment, we employed an Abeta injection model. Using this model, the present study demonstrated that pretreatment with fluvastatin, but not post-treatment just after Abeta exposure, prevented Abeta-induced memory impairment. We also observed that fluvastatin significantly decreased Abeta accumulation and oxidative stress after Abeta injection. Mice treated with simvastatin, but not fluvastatin, did not demonstrate the prevention of Abeta-induced memory impairment, and showed no significant decrease in oxidative stress. More importantly, fluvastatin significantly prevented the loss of neurons in the basal forebrain induced by Abeta. Overall, the present study demonstrated that fluvastatin significantly prevented memory impairment induced by Abeta. The beneficial effects of fluvastatin might be explained by the preservation of neurons through a significant decrease in Abeta accumulation and oxidative stress. In clinical practice, the timing of the start of fluvastatin treatment might be critical in achieving a beneficial effect on cognitive function.

PMID: 18425343 [PubMed – in process]

(Source: International Journal of Molecular Medicine)]></span>
Reovirus activates human dendritic cells to promote innate antitumor immunity.

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Reovirus Activates Human Dendritic Cells to Promote Innate Antitumor Immunity.

J Immunol. 2008 May 1;180(9):6018-6026

Authors: Errington F, Steele L, Prestwich R, Harrington KJ, Pandha HS, Vidal L, de Bono J, Selby P, Coffey M, Vile R, Melcher A

Oncolytic viruses can exert their antitumor activity via direct oncolysis or activation of antitumor immunity. Although reovirus is currently under clinical investigation for the treatment of localized or disseminated cancer, any potential immune contribution to its efficacy has not been addressed. This is the first study to investigate the ability of reovirus to activate human dendritic cells (DC), key regulators of both innate and adaptive immune responses. Reovirus induced DC maturation and stimulated the production of the proinflammatory cytokines IFN-alpha, TNF-alpha, IL-12p70, and IL-6. Activation of DC by reovirus was not dependent on viral replication, while cytokine production (but not phenotypic maturation) was inhibited by blockade of PKR and NF-kappaB signaling. Upon coculture with autologous NK cells, reovirus-activated DC up-regulated IFN-gamma production and increased NK cytolytic activity. Moreover, short-term coculture of reovirus-activated DC with autologous T cells also enhanced T cell cytokine secretion (IL-2 and IFN-gamma) and induced non-Ag restricted tumor cell killing. These data demonstrate for the first time that reovirus directly activates human DC and that reovirus-activated DC stimulate innate killing by not only NK cells, but also T cells, suggesting a novel potential role for T cells in oncolytic virus-induced local tumor cell death. Hence reovirus recognition by DC may trigger innate effector mechanisms to complement the virus’s direct cytotoxicity, potentially enhancing the efficacy of reovirus as a therapeutic agent.

PMID: 18424722 [PubMed – as supplied by publisher]

(Source: Journal of Immunology)]></span>
Endocrine manipulation in male infertility.

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Endocrine Manipulation in Male Infertility.

Urol Clin North Am. 2008 May;35(2):303-318

Authors: Kim HH, Schlegel PN

Endocrine therapy for male infertility is broadly categorized as specific or nonspecific therapy. Although uncommon, primary endocrine diagnoses in infertile men are amenable to targeted therapy. The efficacy of empiric endocrine therapy for idiopathic male infertility, however, has not been demonstrated conclusively by clinical trials. With better understanding of the underlying pathophysiology of idiopathic male infertility, careful evaluation of endocrine therapy in well-selected treatment groups and well-designed randomized, controlled trials is warranted. Although empiric endocrine therapy for idiopathic male infertility has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, perhaps as combination therapy.

PMID: 18423250 [PubMed – as supplied by publisher]

(Source: The Urologic Clinics of North America)]>
Assessing diagnostic confidence a comparative review of analytical methods.
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Assessing diagnostic confidence a comparative review of analytical methods.

Acad Radiol. 2008 May;15(5):584-92

Authors: Ng CS, Palmer CR

RATIONALE AND OBJECTIVES: The ability of a test to influence diagnostic confidence is used as a measure of its efficacy. Our aim was to compare analytic methods that evaluate changes in confidence. MATERIALS AND METHODS: The approaches compared were “basic,” “retained diagnoses,” “Omary,” “Tsushima,” and “score-based” methods. For illustration, data from a clinical study assessing changes in diagnostic confidence (0%-100%) before and after abdominopelvic computed tomography (CT) in patients with acute abdominal pain were used. RESULTS: The basic, retained diagnoses and Omary methods all ignore whether the test yields a correct diagnosis (confident, but incorrect, diagnoses are regarded positively). Although the Tsushima method takes some account of diagnostic accuracy, all misdiagnoses are considered equal. The score-based method addresses some of the fundamental limitations in the other analyticl methods, such as diagnostic accuracy and the varying nature of different misdiagnoses. In the case study, mean (SD) diagnostic confidence for the cohort as a whole (n = 62) increased following CT: 50.7% (20.8%) to 73.2% (20.9%). Pretest diagnoses were changed following CT in 43% (27 of 62) of patients. Pretest diagnoses proved to be incorrect in 52% (32 of 62), and post-test diagnoses incorrect in as many as 19% (12 of 62) of patients. All five analytic methods indicated a positive contribution for CT (all P

PMID: 18423315 [PubMed – in process]

(Source: Academic Radiology)]>
Critique of the transitional year internship and its relationship to radiology residency.
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Critique of the transitional year internship and its relationship to radiology residency.

Acad Radiol. 2008 May;15(5):662-8

Authors: Baker SR, Tilak GS, Thakur U

RATIONALE AND OBJECTIVES: The purpose of the study is to determine if transitional year program (TYP) requirements foster realization of standards of excellence and clinical relevance for future radiologists and to explore demographic and economic factors pertinent to TYPs. MATERIALS AND METHODS: A list of accredited TYPs were obtained from the American Medical Association’s Graduate Medical Education (ACGME) Directory 2006-2007. Specialty distribution of TYP graduates was examined from statistics provided by the ACGME, and data from the 2007 Main Residency Match was analyzed. Data derived from a concurrent survey of the perception of the value of internship sent to all current radiology residents and fellows was assessed. The institutional costs of employing TYP interns versus physician assistants were also calculated. RESULTS: Forty-one of the 125 TYPs lack residencies in internal medicine (IM), general surgery (GS), or both, and approximately two-third of these lack full medical school affiliation. The interns who will graduate from these 41 programs account for 103 of the 1,128 radiology residents in their post-graduate year 2. Despite the longest elective time offered in TYPs compared to conventional preliminary programs, current radiology trainees who had participated in preliminary IM or GS internships were more satisfied compared to trainees completing TYPs. CONCLUSIONS: The requirements of the transitional internship and compliance with them need to be carefully assessed to determine their efficacy. Despite the strong economic impetus for hiring TYP interns, the availability of open slots in existing preliminary programs in IM and GS, coupled with radiology residents’ greater level of satisfaction with traditional over transitional internships, makes the existence of TYPs less compelling.

PMID: 18423324 [PubMed – in process]

(Source: Academic Radiology)]>
Noninvasive system shows efficacy in delivering high dose rate brachytherapy
The efficacy of the CyberKnife robotic radiosurgery system in delivering complex, high dose rate (HDR)
brachytherapy to the prostate noninvasively without the need for hospitalization or anesthesia has been reported in
the International Journal of Radiation Oncology Biology Physics (2008; 70:1588-97). (Source: UrologyTimes – Prostate Cancer)

Sharing bed with wife helps men’s sleep apnea rx
(Source: Health Behavior News Digest)
First method for testing, assessing drug treatments for chagas’ disease identified
Scientists have identified for the first time a sensitive method for testing and assessing the efficacy of treatments for Chagas’ disease. The study could lead to new treatments for long-term sufferers of a disease that can be fatal. (Source: ScienceDaily Headlines)
Director’s testimony: fiscal year 2009 budget request
I am pleased to present the President’s Fiscal Year (FY) budget request for the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health. The FY 2009 budget includes 21,695,000, which is 18,000 more than the comparable FY 2008 appropriation of 21,577,000.

The public’s concept of health is broader than preventing and treating disease. Increasingly, Americans are using strategies that they can employ themselves to improve their health, maintain wellness, and improve quality of life. As part of this participatory approach to health, millions of people are using complementary and alternative medicine (CAM). Many of the leading U.S. medical institutions now offer integrative medicine services. These programs include personalized CAM interventions such as yoga, meditation, massage, and acupuncture. However, we know relatively little about the true potential of CAM to improve health and well being or to preempt disease, or about how best to use most CAM modalities. We also need to understand how CAM practices interact with other therapies and whether they are safe.

Given this consumer-driven call for better approaches to improved health and wellness, the medical research community has begun to explore promising CAM approaches and develop the scientific evidence base for CAM modalities that can be integrated as part of comprehensive health care. Using proven scientific methods and rigorous standards, NCCAM is building the research enterprise and the evidence base to better understand CAM. Through scientific investigation, research training programs, and outreach activities, NCCAM’s efforts will support the rational integration of proven CAM approaches with conventional medicine. (Source: NCCAM Featured Content)
Chelsea announces publication of clinical autonomic research
supplement focusing on neurogenic orthostatic hypotension

Chelsea Announces Publication of Clinical Autonomic Research
Supplement Focusing On Neurogenic Orthostatic Hypotension
Publication Highlights Efficacy of Droxidopa in Key European and
U.S. Trials and Provides Insight Into Initial… (Source: Drugs.com – Clinical Trials)

Long-term effects of pegvisomant in patients with acromegaly
Some patients with acromegaly cannot attain biochemical remission despite various therapeutic approaches. Pegvisomant suppresses insulin-like growth factor 1 production. The efficacy and related risks and benefits of this therapy for acromegaly are described. Nature Clinical Practice Endocrinology & Metabolism (Source: Medscape FamilyMedicine Headlines)
Curcumin restores corticosteroid function
Curcumin, a dietary polyphenol most commonly found in curry, restores oxidative-stress-impaired histone deacetylase-2 activity and corticosteroid efficacy in monocytes, researchers report. (Source: MedWire News – Respiratory)
Re: effect of short-term hospitalization on functional capacity in patients not restricted to bed.
Page: 425DOI: 10.1097/PHM.0b013e31816dd045Authors: Kortebein, Patrick MD (Source: American Journal of Physical Medicine & Rehabilitation)
Re: effect of short-term hospitalization on functional capacity in patients not restricted to bed.
Page: 425DOI: 10.1097/PHM.0b013e31816dda18Authors: Carvalho, Celso R. F. MD (Source: American Journal of Physical Medicine & Rehabilitation)
Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach.
Page: 197DOI: 10.1097/SLE.0b013e318168dda4Authors: Kim, Jung Han MD *; Choi, Young Jin MD *; Kim, Ji A. MD *; Gil, Won Ho MD *; Nam, Seok Jin MD, PhD *; Oh, Young Lyun MD +; Yang, Jung-Hyun MD, PhD, FACS * (Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques)
Safety and efficacy of prk and lasik in pediatric patients.
Page: 193DOI: 10.1097/IIO.0b013e31816923d9Authors: Qian, Ying MD, PhD; Pineda, Roberto MD (Source: International Ophthalmology Clinics)
48-week pooled data from motivate 1 and 2 confirm durable efficacy, safety of maraviroc in treatment-experienced patients with r5 hiv-1
In treatment-experienced patients infected with R5 HIV-1, maraviroc plus OBR provided greater virologic, immunologic efficacy over 48 weeks of follow-up vs OBR alone (Source: Clinical Care Options HIV)
Interim analysis of phase i/ii study of rexin-g confirms efficacy with no dose limiting toxicity in metastatic pancreatic cancer
Epeius Biotechnologies Corporation announced that Interim Analysis of an on-going Phase I/II study of Rexin-G for pancreatic cancer confirmed Rexin-G’s anti-tumor activity with no major toxicity in patients with metastatic chemotherapy-resistant pancreatic cancer. The clinical trial design includes 5 escalating doses of intravenous Rexin-G ranging from 1 x 10e11 cfu twice a week to 4 x 10e11 cfu three times a week for 4 weeks. (Source: Cancer / Oncology News From Medical News Today)
Oral cephalexin for acne vulgaris: clinical experience with 93 patients
Pediatric Dermatology, Volume 25, Issue 2, Page 179-183, March/April 2008.

Abstract:�For patients who fail traditional acne therapy or experience side effects, other treatments are needed. Cephalexin has been noted to be efficacious in some instances. This study aimed to assess the therapeutic efficacy of cephalexin for acne. A … (Source: Pediatric Dermatology)
Length of stay and associated costs of obesity related hospital admissions in ireland
Background:
Obesity is the cause of other chronic diseases, psychological problems, obesity shortens the lifespan and puts strain on health systems. The risk associated with childhood obesity in particular, which will accelerate the development of adult morbidity and mortality, has been identified as an emerging public health problem.
Methods:
To estimate the length of stay and associated hospital costs for obesity related illnesses, a cost of illness study was set up. All discharges from acute hospitals in the Republic of Ireland from 1997 to 2004 with a principal or secondary diagnostic code for obesity for all children from 6 to 18 years of age and for adults were collected.
A discharge frequency was calculated by dividing obesity related discharges by the total number of diagnoses (principal and secondary) for each year. The hospital costs related to obesity was calculated based on the total number of days care.
Results:
The discharge frequency of obesity related conditions increased from 1.14% in 1997 to 1.49% in 2004 for adults and from 0.81% to 1.37% for children. The relative length of stay (number of days in care for obesity related conditions per 1000 days of hospital care given) increased from 1.47 in 1997 to 4.16 in 2004 for children and from 3.68 in 1997 to 6.74 in 2004 for adults.
Based on the 2001 figures for cost per inpatient bed day, the annual hospital cost was calculated to be 4.4 Euromillion in 1997, increasing to 13.3 Euromillion in 2004. At a 20% variable hospital cost the cost ranges from 0.9 Euromillion in 1997 to 2.7 Euromillion in 2004; a 200% increase.
Conclusions:
The annual increase in the proportion of hospital discharges related to obesity is alarming. This increase is related to a significant increase in economic costs. This paper emphasises the need for action at an early stage of life. Health promotion and primary prevention of obesity should be high on the political agenda. (Source: BioMed Central)

Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: a protocol for a randomised double-blind placebo- controlled trial.
Background:
Major shoulder surgery often results in severe post-operative pain and a variety of interventions have been developed in an attempt to address this. The continuous slow infusion of a local anaesthetic directly into the operative site has recently gained popularity but it is expensive and as yet there is little conclusive evidence that it provides additional benefits over other methods of post-operative pain management.
Methods:
This will be a randomised, placebo-controlled trial involving 158 participants. Following diagnostic arthroscopy, all participants will undergo either arthroscopic subacromial decompression with or without rotator cuff repair, by a single surgeon. Participants, the surgeon, nurses caring for the patients and outcome assessors will be blinded to treatment allocation. A pre-incision bolus injection of 10mls of ropivacaine 1% into the shoulder and an intra-operative intravenous bolus of parecoxib 40mg.will be given. Using concealed allocation participants will be randomly assigned to active treatment (local anaesthetic ropivacaine 0.75%) or placebo (normal saline) administered continuously into the subacromial space by an elastometric pump at 5 mls per hour post-operatively. Patient controlled opioid analgesia and oral analgesics will be available for breakthrough pain. Outcome assessment will be at 15, 30 and 60 minutes, 2, 4, 8, 12, 18 and 24 hours, and 2 or 4 months for decompression or decompression plus repair respectively.
The primary end point will be the average pain at rest over the first 12-hour post-operative period, on a verbal analogue pain score from 0 to 10.. Secondary end points will be average pain at rest over the second 12-hour post-operative period, maximal pain at rest over the first and second 12-hour periods, amount of rescue medication used, length of inpatient time following decompression, and decompression plus repair, and the incidence of post-operative adhesive capsulitis up to 2 or 4 months following decompression or decompression plus repair respectively.DiscussionThe results of this trial will contribute to evidence-based recommendations for the effectiveness of pain management modalities following arthroscopic rotator cuff surgery. If the local anaesthetic pain-buster provides no additional benefits over placebo then valuable resources can be put to better use in other ways. (Source: BMC Musculoskeletal Disorders)

A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis
Background:
Allergies cause a considerable burden to both sufferers and the National Health Service. There is growing interest in acupuncture as a treatment for a range of conditions. Since acupuncture may modulate the immune system it could be a useful treatment for allergic rhinitis (AR) sufferers. We therefore assessed the evidence for the clinical effectiveness of acupuncture in patients with AR by performing a systematic review of the literature.
Methods:
Searches (to 2007) were conducted in all major databases for randomised controlled trials (RCTs) evaluating the clinical effectiveness of acupuncture in the treatment of AR. No limits were placed on language. Studies were included if they compared acupuncture to a sham or inactive acupuncture treatment (placebo) with or without standard care. Meta-analysis was performed where feasible.
Results:
Seven relevant RCTs were included after screening and application of inclusion and exclusion criteria. The trials were generally of poor quality as assessed by a modified Jadad scale, with the exception of two studies which scored highly. A wide variety of outcomes was measured but most assessed symptom severity on a visual analogue scale. A meta-analysis failed to show any summary benefits of acupuncture treatment for symptom severity scores or serum IgE measures which could not have been accounted for by chance alone. Acupuncture was not associated with any additional adverse events in the trials.
Conclusion:
There is currently insufficient evidence to support or refute the use of acupuncture in patients with AR. A large well conducted RCT, which overcomes identified methodological problems in the existing RCTs, would be required to resolve this question. (Source: BMC Complementary and Alternative Medicine)

Mutagenicity of 42 chemicals in salmonella
The mutagenicity results and data for 42 chemicals are reported. All chemicals were tested using the Salmonella/microsome assay preincubation protocol, and four were also tested using vapor phase exposure in a desiccator. These comprise the chemicals studied in the update of the National Toxicology Program’s evaluation of the efficacy of in vitro short-term tests for detecting carcinogens and noncarcinogens. (Source: Environmental and Molecular Mutagenesis)
[hepatobiliary imaging] ct laparoscopy for detecting small superficial metastatic lesions of the liver surface: initial experience
OBJECTIVE. The purpose of this study was to determine the efficacy
of CT laparoscopy in the detection of superficial metastasis of the liver
surface.
SUBJECTS AND METHODS. From April 1, 2007, to July 1, 2007, a total
of 34 consecutively registered patients (19 men, 15 women; median age, 55
years) with various intraabdominal malignant tumors underwent preoperative CT
and composed the study population. All patients underwent superparamagnetic
iron oxide&ndash;enhanced MRI and portal phase contrast-enhanced 64-MDCT,
including CT laparoscopy. CT laparoscopy is a form of volume-rendering 3D
imaging of the liver that depicts the liver surface in detail.
RESULTS. Among 23 patients who underwent surgery for management of a
primary tumor, four patients had seven superficial metastatic lesions of the
liver surface. None of these lesions had been detected with preoperative axial
CT or superparamagnetic iron oxide&ndash;enhanced MRI. In contrast, CT
laparoscopy revealed four of seven lesions in four patients. On a
lesion-by-lesion basis, the sensitivity was 57%, the positive predictive value
was 100%, and the accuracy was 57%.
CONCLUSION. Our initial experience proves that CT laparoscopy is a
promising method for detecting small superficial metastatic lesions of the
liver surface. The findings can influence decisions regarding tumor
resectability. (Source: American Journal of Roentgenology)

[forensic radiology] postmortem whole-body ct angiography: evaluation of two contrast media solutions
OBJECTIVE. The objective of our study was to establish a
standardized procedure for postmortem whole-body CT-based angiography with
lipophilic and hydrophilic contrast media solutions and to compare the results
of these two methods.
MATERIALS AND METHODS. Minimally invasive postmortem CT angiography
was performed on 10 human cadavers via access to the femoral blood vessels.
Separate perfusion of the arterial and venous systems was established with a
modified heart&ndash;lung machine using a mixture of an oily contrast medium
and paraffin (five cases) and a mixture of a water-soluble contrast medium
with polyethylene glycol (PEG) 200 in the other five cases. Imaging was
executed with an MDCT scanner.
RESULTS. The minimally invasive femoral approach to the vascular
system provided a good depiction of lesions of the complete vascular system
down to the level of the small supplying vessels. Because of the enhancement
of well-vascularized tissues, angiography with the PEG-mixed contrast medium
allowed the detection of tissue lesions and the depiction of vascular
abnormalities such as pulmonary embolisms or ruptures of the vessel wall.
CONCLUSION. The angiographic method with a water-soluble contrast
medium and PEG as a contrast-agent dissolver showed a clearly superior quality
due to the lack of extravasation through the gastrointestinal vascular bed and
the enhancement of soft tissues (cerebral cortex, myocardium, and parenchymal
abdominal organs). The diagnostic possibilities of these findings in cases of
antemortem ischemia of these tissues are not yet fully understood. (Source: American Journal of Roentgenology)

Could laser surgery finally put the curse of snoring to bed?
ANYONE who has ever shared a bed with a snorer knows the torture of sleepless nights and the arguments that can follow. Now surgeons hope a revolutionary laser technique could (Source: Scotsman.com News – Health)
Raloxifene safely increases bmd in women with chronic kidney disease?
According to the results of a subgroup analysis, treatment with raloxifene safely increases bone mineral density (BMD) in postmenopausal women with chronic kidney disease and cuts the risk of vertebral fractures.

While patients with chronic renal disease are known to be at increased risk for bone loss, women with elevated creatinine levels are usually excluded from trials of osteoporosis drugs, according to the report in the April 9th online issue of the Journal of the American Society of Nephrology.

The authors note that the majority of clinical trials evaluating pharmacological therapies in preventing fractures in postmenopausal women have excluded those with renal impairment. It is therefore uncertain whether the beneficial effects of osteoporosis therapy extend to those with kidney disease, and whether such therapies are safe in this patient population. They therefore used data from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial to examine the efficacy and safety of raloxifene in risk subgroups defined at baseline according to presence and severity of chronic kidney disease (CKD).

MORE was a multicentre, international placebo controlled trial of the effects of raloxifene on BMD and fracture incidence in postmenopausal women over three years (n=7316). Baseline serum creatinine values were used to assign participants to a category of creatinine clearance (calculated using Cockcroft-Gault formula). Among the cohort, 1480 (20%) had a CrCl of &lt;45 ml/min, 3493 (48%) had a CrCl of 45 to 59 ml/min, and 2343 (32%) had CrCl =60 ml/min. Among the women with a CrCl &lt;45 ml/min, only 55 had a CrCl &lt;30 ml/min, and the lowest was CrCl 20.0 ml/min. There were several differences in baseline characteristics across categories of CrCl; e.g. women with lower CrCl were more likely to be older and more years postmenopausal; to have a lower body mass index (BMI); to have a lower baseline BMD and to have prevalent fractures. BMD was measured at baseline and then annually with dual x-ray absorptiometry (DEXA).

The main findings were as follows:

? In the placebo group, a lower CrCl at baseline correlated with higher annual losses of BMD at the femoral neck, but this trend did not reach statistical significance (p=0.09). In the raloxifene group, lower CrCl at baseline correlated with greater increases in the femoral neck BMD (P=0.01 for trend).

? Compared with placebo, the effect of raloxifene on increasing femoral neck BMD was 1.0% per year among women with a CrCl &lt;45 ml/min, 0.7% per year among women with a CrCl of 45 to 59 ml/min, and 0.6% per year among women with a CrCl =60 ml/min (P &lt;0.001 for all comparisons between pooled raloxifene treatment group and placebo group).

? Raloxifene was associated with an overall decrease in the incidence of vertebral fractures (odds ratio [OR] 0.57; 95% CI 0.47 to 0.69), and there was no evidence that this effect differed according to CrCl at baseline. In addition, the effect of raloxifene on rate of change in spine BMD did not differ according to renal function.

? Women with reduced kidney function overall were more likely to experience one or more serious adverse effects and to discontinue the study permanently as a result of an adverse event; however, the rates of adverse events were similar between the raloxifene and placebo groups within each category of kidney function.

The authors conclude that their results support the use of raloxifene as a safe and effective means to increase BMD and prevent vertebral fractures in postmenopausal women with osteoporosis and compromised kidney function. [Editor?s note: as this was a subgroup analysis, the findings need to be confirmed in a prospective trial adequately powered to test this]. (Source: NeLM Headline News)
Cochrane review: clobazam as an add-on in the management of refractory epilepsy
According to the findings of a systematic review conducted by the Cochrane Collaboration, clobazam may reduce seizure frequency as an add-on treatment, and may be most effective in partial onset seizures, however further study is required to determine who will best benefit and over what time-frame.

The authors note that up to 30% of patients with epilepsy continue to suffer from seizures, despite multiple combinations of antiepileptic drugs (AEDs). Although the 1,4-benzodiazepines have a clear role in the acute management of epileptic seizures, they are associated with a number of disadvantages, including short half-life (lorazepam) and accumulation in fat stores (diazepam). Clobazam is a 1,5-benzodiazepine that has long been used as an adjunct to reduce seizure frequency; it has a broader spectrum of antiepileptic activity and a long half life (active metabolite ? 35-133 hours). Although there have been concerns over its long-term use (e.g. sedation and development of tolerance), the data to support these are limited and come from open, unrandomised trials, with widely ranging variation in the definition of ‘tolerance’. The aim of this review was to examine the efficacy of clobazam as an add-on treatment in the management of refractory cases of epilepsy, of partial onset with or without secondary generalisation and generalised tonic clonic seizures, in both adults and children, with regard to seizure reduction, side effects and tolerance.

A total of four randomised, double-blind, placebo-controlled cross-over studies meeting the inclusion criteria were included (Total n=196), however it was not possible to carry out a meta-analysis due to differences between them in terms of methodology and outcome measures. Only two of the studies reported a 50% or greater seizure reduction compared to placebo as an outcome measure; 57.7% and 52.4%. The remaining two studies did not report this outcome, although one reported that 40% achieved a 75% or more reduction in seizure frequency. Side effects were only described in two of the studies, reportedly present in 36% and 85% of patients.

For a description of each of the studies, including data on withdrawal, efficacy, side effects and quality of life, please see the full publication at the link above. The authors say that their results suggest that clobazam as an add-on therapy reduces seizure frequency for drug refractory partial epilepsy, but that there are limited and inconclusive data for generalised epilepsy. (Source: NeLM Headline News)
Cochrane review: recombinant interferon beta or glatiramer acetate for delaying conversion of the first demyelinating event to multiple sclerosis
According to the authors of a Cochrane systematic review, early treatment with interferon (IFN) beta delays the conversion from clinically isolated syndromes (CIS) to clinically definite multiple sclerosis (CDMS), over two years of follow up.

Epidemiological studies have shown that CIS suggestive of demyelinating events carry a high risk to convert to CDMS, particularly if the MRI scan has typical white matter lesions. The reviewers carried out a systematic review of the literature to identify all randomised trials of adequate quality comparing either IFN beta or glatiramer acetate (GA) treatment to placebo in patients with CIS, although none for the latter were located. The three trials meeting the inclusion criteria assessed the following (total n=1160):

? IFN beta 1a 30 mcg weekly by intramuscular injection (CHAMPS trial)
? IFN beta 1a 22 mcg weekly by subcutaneous injection (ETOMS)
? IFN beta 1 b 250 mcg every other day by subcutaneous injection (BENEFIT)

As the primary endpoints used differed slightly, each trial was analysed separately in addition to the meta-analysis. The main results were as follows (per-protocol):

? CHAMPS: at one year the risk of conversion was 16% in participants receiving IFN and 24% in those receiving placebo (OR 0.59, 95% CI 0.34 to 1.01, p=0.05). The conversion to CDMS would be prevented in 8 (95 % CI 0 to 17) of 100 CIS patients during the first year of IFN treatment.

? ETOMS: at one year the risk of conversion was 25% in participants receiving IFN and 37% in those receiving placebo (OR 0.57, 95% CI 0.35 to 0.94, p=0.03) and at two years the risk was 34.6% and 46%, respectively (OR 0.62, 95% CI 0.39 – 0.99, p=0.05).

? BENEFIT: at one year the risk of conversion was 18% in participants receiving IFN and 31% in those receiving placebo (OR 0.48, 95% CI 0.31 to 0.74, p=0.0009) and at two years the risk was 26% and 44%, respectively (OR 0.44, 95% CI 0.30 to 0.66, p&lt;0.0001)

? META-ANALYSES: at one year the risk of conversion was 19% in patients receiving IFN and 30% in those receiving placebo (pooled OR of 0.53, 95% CI 0.40 to 0.71, p&lt;0.0001). The results show that the conversion to CDMS would be delayed for 12 months in 11 (95 % CI 6 to 16) of 100 CIS patients during the first year of IFN treatment. At two years, the risk of conversion was 29% in patients receiving IFN and 45% in those receiving placebo (pooled OR of 0.52, 95% CI 0.38 to 0.70 p&lt; 0.0001).

The authors note that the interpretation of these results may be limited due to some quality issues, e.g. the ETOMS trial did not indicate whether the investigators were blinded to treatment, and the number of patients in the CHAMPS study lost to follow-up during the second year of study was quite high (around 40%). As patients had some clinical heterogeneity (length of follow-up, clinical findings of initial attack), they suggest that it could be useful for clinical practice to further analyse the efficacy of IFN beta treatment in different patient subgroups. (Source: NeLM Headline News)
Herpes zoster vaccine acts by boosting virus-specific immune response
The proven efficacy of a high-potency live-attenuated varicella-zoster virus (VZV) vaccine is based on its ability to boost VZV-specific cell-mediated immunity and VZV antibody levels. Reuters Health Information (Source: Medscape Infectious Diseases Headlines)
Interim analysis of phase i/ii study of rexin-g confirms efficacy
with no dose limiting toxicity in metastatic pancreatic cancer;
second phase opens with higher dose regimens

SAN MARINO, Calif., April 21, 2008 (SEND2PRESS NEWSWIRE) —
Epeius Biotechnologies Corporation announced today that Interim
Analysis of an on-going Phase I/II study of Rexin-G for pancreatic
cancer confirmed Rexin-G’s anti-tumor activity with no… (Source: Drugs.com – Clinical Trials)

Interim analysis of phase i/ii study of rexin-g confirms efficacy
with no dose limiting toxicity in metastatic pancreatic cancer

Second Phase Opens With Higher Dose Regimens
SAN MARINO, Calif., April 21, 2008 /PRNewswire/ — Epeius
Biotechnologies Corporation announced today that Interim Analysis
of an on-going Phase I/II study of Rexin-G for pancreatic cancer
confirmed… (Source: Drugs.com – Clinical Trials)

Development and efficacy of nxy-059 for the treatment of acute ischemic stroke
Future Neurology , May 2008, Vol. 3, No. 3, Pages 229-240.

NXY-059 is a neuroprotective compound that prevents ischemic damage by trapping free radicals. Preclinical animal stroke models demonstrated that the agent is able to reduce histological damage and improve behavioral outcome. Phase�II studies showed that … (Source: Future Neurology)
Mental health page from cam sl acupuncture evidence update 2008
Systematic reviews on acupuncture and anxiety or insomnia, as part of the Complementary and Alternative Medicine specialist library’s Acupuncture Evidence Update. (Source: Mental Health Specialist Library Newsfeed)
Uganda: is uganda safe from india’s fake drugs?
The Economist (London) of February 23 indirectly touched on a subject that has long troubled me: the efficacy of drugs manufactured in India. In an article about India’s fake doctors titled ‘Quackdown’, The Economist revealed that India has more fake doctors than genuine ones. (Source: AllAfrica News: Health and Medicine)
Insert therapeutics to initiate a multinational phase ii clinical trial of lead drug candidate it-101 in ovarian cancer
Insert Therapeutics, Inc., a majority owned subsidiary of Arrowhead Research Corporation (ARWR), announced that it has filed with the U.S. Food and Drug Administration to initiate a Phase II clinical trial evaluating the safety and efficacy of its drug candidate IT-101 in patients with ovarian cancer. In women who receive a 2nd course of chemotherapy, nearly 75% will achieve some degree of disease stabilization. (Source: Cancer / Oncology News From Medical News Today)
Memorial hospital marks 50 years with er expansion
Mark Turner took the reins at Memorial Hospital in Belleville in August of 2006, just the third president to lead the 313-bed hospital, which is celebrating its 50th anniversary this year. He took on the top spot at Memorial Hospital, which had $220 million in 2007 revenue, after the retirement of Harry Maier. (Source: bizjournals.com Health Care:Hospitals headlines)
Endoscopic resection of hypothalamic hamartomas for refractory symptomatic epilepsy
Background: Hypothalamic hamartomas (HHs), rare developmental abnormalities of the inferior hypothalamus, often cause refractory, symptomatic, mixed epilepsy, including gelastic seizures. We present 37 patients with HH who underwent transcortical transventricular endoscopic resection.
Methods: Between October 2003 and April 2005, 42 consecutive patients with refractory epilepsy who underwent endoscopic resection of HH were studied prospectively. The endoscope was held by an articulated pneumatic arm and tracked with a frameless stereotactic neuronavigation system. Data collection and follow-up were performed by personal interview. Five patients were excluded. The remaining 37 patients (22 males, 15 females; median age 11.8 years; range 8 months to 55 years) had frequent and usually multiple types of seizures.
Results: Postoperative MRI confirmed 100% resection of the HH from the hypothalamus in 12 patients. At last follow-up (median 21 months; range 13&ndash;28 months), 18 (48.6%) patients were seizure free. Seizures were reduced more than 90% in 26 patients (70.3%) and by 50% to 90% in 8 patients (21.6%). Overall, the mean postoperative stay was shorter in the endoscopic patients compared with our previously reported patients who underwent transcallosal resection (mean 4.1 days vs 7.7 days, respectively; p = 0.0006). The main complications were permanent short-term memory loss in 3 patients and small thalamic infarcts in 11 patients (asymptomatic in 9).
Conclusions: Endoscopic resection of hypothalamic hamartoma (HH) is a safe and effective treatment for seizures. Its efficacy seems to be comparable to that of transcallosal resection of HH, but postoperative recovery time is significantly shorter. (Source: Neurology)

[original articles] b cell depletion therapy for 19 patients with refractory systemic lupus erythematosus
Objective:
B cell dysregulation is involved in the development of childhood-onset systemic lupus erythematosus (SLE). The safety and efficacy of B cell depletion therapy is evaluated in the the largest series of children to be presented in the literature.

Methods:
19 children (89% female) with SLE, aged 6&ndash;16 (median 14) years, treated with rituximab in a single centre were retrospectively reviewed. The British Isles Lupus Assessment Group (BILAG) index and biochemical, haematological and immunological parameters were evaluated before and after treatment, with the primary outcome assessed as normal results. Rituximab therapy was used for acute life- or organ-threatening symptoms or symptoms that had not responded to standard treatment. The range of symptoms included lupus nephritis, cerebral lupus and severe general symptoms. Rituximab 750 mg/m2 was given intravenously twice, usually within a 2-week period. Patients were followed up for 6&ndash;38 (median 20) months.

Results:
Rapid reduction of SLE disease activity was observed within the first month, represented by a reduction of BILAG scores (14 to 6, p&lt;0.005) and an improvement in renal function (estimated glomerular filtration rate of 54 to 68 ml/min/1.73 m2, p = 0.07), immunological (complement C3: 0.46 to 0.83 g/l, p = 0.02) and haematological (haemoglobin: 9.7 to 10.3 g/dl, p = 0.04) parameters. No serious side effects were observed, except for herpes zoster in five cases.

Conclusion:
In our cohort of children, rituximab was safe and effective when used in combination with standard immunosuppressive agents. Randomised controlled studies are needed to further evaluate the safety and efficacy of rituximab therapy. (Source: Archives of Disease in Childhood)
Livelihood, poverty and morbidity: a study on health and socio-economic status of the tribal population in orissa
The tribals of the Orissa not only deserve a sustainable form of livelihood, but also proper access to adequate health care facilities, as poverty and morbidity go together to cause vicious circle. Because of a higher incidence of poverty, tribals fail to acquire adequate calories, nutrition and vitamins to keep them immune from various diseases. On the other hand, poverty further diminishes their earning capability due to the affliction of various seasonal and endemic diseases round the year. Hence, for the capacity building of poor tribals to enable them to come out of the poverty trap, apart from livelihood-sustaining measures in an era of economic liberalisation and globalisation, strengthening of public health care facilities in tribal areas needs foremost attention. More so as tribals are usually found to be residing in environmentally adverse and physically less accessible areas, with scattered human settlements, and are more vulnerable to various types of endemic, contagious and seasonal diseases due to mass poverty, ignorance and absence of proper health care in-frastructure and services. Based on the field data collected on different occasions in different tribal districts of Orissa for various research studies and also from published secondary data, this article makes an attempt to analyse the livelihood patterns and living conditions of the tribals of Orissa, and the concomitant morbidity and status of health care services in the tribal regions of the state. The article also critically examines the existing health care policy of the state and its efficacy and relevance for the downtrodden in the present context of economic reforms, and the withdrawal of the state from subsidised health care services. (Source: Journal of Health Management)
Reduction in magnetic resonance imaging t2 burden of disease in patients with relapsing-remitting multiple sclerosis: analysis of 48-week data from the evidence (evidence of interferon dose-response: european north american comparative) study
Background:
The EVIDENCE (EVidence of Interferon Dose-response: European North American Comparative Efficacy) study was an international, randomized, open-label, assessor-blinded, parallel-group study assessing the efficacy and tolerability of interferon (IFN) beta-1a, 44 mcg subcutaneously (sc) three times weekly (tiw), and IFN beta-1a, 30 mcg intramuscularly (im) once weekly (qw), in patients with relapsing-remitting multiple sclerosis (RRMS). The aim of this analysis was to assess whether reductions in T2 burden of disease (BOD) were greater for patients receiving IFN beta-1a, 44 mcg sc tiw, than for those treated with IFN beta-1a, 30 mcg im qw, and to assess the impact of neutralizing antibodies (NAbs).
Methods:
A post-hoc analysis was performed on magnetic resonance imaging (MRI) data collected prospectively from the EVIDENCE study. The analysis included all patients with evaluable T2 MRI scans at the start of dosing and at week 48, and those who received at least one drug dose (n = 553). Lesions were identified by a radiologist blinded to treatment codes and the total volume of T2 lesions (BOD) was reported in mm3.
Results:
Both median percentage decreases and absolute reduction in BOD were greater in the IFN beta-1a, 44 mcg sc tiw, treatment group. The adjusted mean treatment difference in percentage change in BOD from baseline to week 48 showed a significant treatment benefit for patients treated with IFN beta-1a, 44 mcg sc tiw, over those treated with IFN beta-1a, 30 mcg im qw (-4.6%; standard error: 2.6%; p = 0.002). The presence of NAbs reduced the effect of IFN beta-1a 44, mcg sc tiw, on BOD, but BOD changes were still similar to those seen with IFN beta-1a, 30 mcg im qw.
Conclusion:
Patients with RRMS treated with IFN beta-1a, 44 mcg sc tiw, had greater reduction in T2 BOD after 48 weeks than those treated with IFN beta-1a, 30 mcg im qw, which is consistent with other clinical and MRI outcome measures in the EVIDENCE study. In patients testing positive for NAbs (NAb+) to IFN beta-1a 44 mcg sc tiw, changes in BOD were smaller than in NAb negative (NAb-) patients, but similar to those receiving IFN beta-1a, 30 mcg im qw. (Source: BMC Neurology)

[reviews] difficult extubation in low birthweight infants
Randomised trials have demonstrated that ventilation techniques which support every spontaneous breath are the most efficacious weaning modes. Nasal continuous positive airway pressure after extubation reduces the likelihood of incidents leading to the need for reintubation in very low birthweight infants; further work is needed to determine if there are advantages of particular delivery techniques. Both methylxanthines and dexamethasone facilitate weaning and extubation; the efficacy of low-dose dexamethasone merits further investigation. Assessments of the efficacy of respiratory efforts and hence the balance of respiratory drive, muscle performance and respiratory load appear to best predict weaning and extubation success. Essential to the success of weaning and extubation are dedicated staff, whether this will be assisted by computerised decision-making tools requires testing. The above approaches are not mutually exclusive and those indicated by this review as appropriately evidence based should be considered by practitioners for current use to reduce difficult/unsuccessful extubation. (Source: Archives of Disease in Childhood – Fetal and Neonatal Edition)
Safety and efficacy of bivalirudin monotherapy in patients with diabetes mellitus and acute coronary syndromes: a report from the acuity (acute catheterization and urgent intervention triage strategy) trial
Objectives
We sought to evaluate clinical outcomes of patients with diabetes mellitus in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, overall and by treatment arm.

Background
In the ACUITY trial, 13,819 patients with moderate- or high-risk acute coronary syndromes (ACS) were randomized to heparin (unfractionated or enoxaparin) plus glycoprotein IIb/IIIa inhibition (GPI), bivalirudin plus GPI, or bivalirudin monotherapy. Compared with heparin plus GPI, bivalirudin monotherapy resulted in similar protection from ischemic events with less major bleeding. Whether these results apply to patients with diabetes is unknown.

Methods
We evaluated the impact of diabetes on 30-day net adverse clinical outcomes (composite ischemia [death, myocardial infarction, or unplanned ischemic revascularization] or major bleeding), overall and by antithrombotic strategy.

Results
Diabetes was present in 3,852 randomized patients (27.9%). Compared with nondiabetic patients, diabetic patients had higher 30-day rates of net adverse clinical outcomes (12.9% vs. 10.6%; p &lt; 0.001), composite ischemia (8.7% vs. 7.2%; p = 0.003), and major bleeding (5.7% vs. 4.2%; p &lt; 0.001). Among diabetic patients, compared with heparin plus GPI, bivalirudin plus GPI resulted in similar rates of net adverse clinical outcomes (14.0% vs. 13.8%; p = 0.89), while bivalirudin monotherapy resulted in a similar rate of composite ischemia (7.9% vs. 8.9%; p = 0.39) and less major bleeding (3.7% vs. 7.1%; p &lt; 0.001), yielding fewer net adverse clinical outcomes (10.9% vs. 13.8%; p = 0.02).

Conclusions
Diabetic patients with ACS managed invasively have higher rates of composite ischemia and major bleeding. Compared with treatment with heparin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding, resulting in a significant reduction in net adverse clinical outcomes. (Source: Journal of the American College of Cardiology)
A safety and efficacy study of a resorbable hydrogel for reduction of post-operative adhesions following myomectomy
BACKGROUND
This multicenter, randomized, single-blind study assessed the safety and efficacy of a resorbable hydrogel (&lsquo;Hydrogel&rsquo;) for the reduction of post-operative adhesion formation following myomectomy.

METHODS
Women (n = 71) who were undergoing laparoscopic (67.6%) or laparotomic myomectomy were randomized (2:1) to Hydrogel (sprayed over surgically treated areas prior to wound closure, n = 48) or to control (standard care, n = 23). Patients (38 Hydrogel, 20 control) returned 8&ndash;10 weeks later for a second look. Adhesions were graded using a modified American Fertility Society (mAFS) scoring method. The primary efficacy measure was the posterior uterus mAFS score.

RESULTS
For Hydrogel and control patients, respectively, mean &plusmn; SD mAFS scores were 0.5 &plusmn; 1.4 and 0.0 &plusmn; 0.0 at baseline, and 1.1 &plusmn; 1.9 and 2.6 &plusmn; 2.2 at the second look. Similarly, mean changes from baseline were 0.8 &plusmn; 2.0 and 2.6 &plusmn; 2.2 (P = 0.01); 95% confidence intervals for these mean changes were (0.16&ndash;1.44) and (1.64&ndash;3.56). Adverse events were reported by 9.6 and 17.4% of Hydrogel and control patients, respectively. No intra-abdominal infections or post-operative site infections were reported.

CONCLUSIONS
This 71-patient study provides the first clinical evidence of the safety and efficacy of Hydrogel for the reduction of adhesions following myomectomy.
The ClinicalTrials.gov Identifier is NCT00562471. (Source: Human Reproduction)
Quetiapine decreases alcohol consumption, craving, and psychiatric symptoms in dually diagnosed alcoholics
Patients with dual diagnosis are often excluded from clinical trials although more than half of all individuals with Bipolar Disorder have a substance abuse problem at some point in their lifetime, representing a high-risk clinical population. The purpose of this study was to investigate the safety and efficacy of quetiapine in the treatment of alcohol dependence comorbid with disorders characterized by high levels of mood and behavioral instability.Twenty-eight subjects, after a detoxification period, were orally treated with flexible doses of quetiapine for 16 weeks. At each assessment patients were evaluated through the Obsessive Compulsive Drinking Scale (OCDS), the Visual Analogue Scale (VAS) for craving, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS), the Young Mania Rating Scale (YMRS), and the Clinical Global Impression (CGI) scale.Forty-three percent of patients remained totally alcohol free, 32% patients relapsed, with an average of 15.4 drinking days in the period of the study (112 days) and 25% dropped-out. Significant reductions from baseline to exit were observed in the OCDS, VAS, BPRS, HDRS, and number of drinking days per week. Changes in alcohol craving correlated with psychiatric symptoms as to BPRS and HDRS, with the highest level of correlation evidenced for the HDRS items of insomnia.In this open-label study, quetiapine decreased alcohol consumption, craving for alcohol, and psychiatric symptoms intensity, maintaining a good level of tolerance. A strength of this study is that the use of quetiapine was not adjunctive with other pharmacological and non-pharmacological treatment. Double-blind placebo-controlled studies are required with a larger study population to confirm these data. In the meantime, for a select group of psychiatric patients, quetiapine may offer some advantages in preventing relapse. Copyright � 2008 John Wiley & Sons, Ltd. (Source: Human Psychopharmacology: Clinical and Experimental)
Efficacy of lamotrigine in the management of chemotherapy-induced peripheral neuropathy
Lamotrigine, an antiepileptic agent, has been reported as being effective in reducing symptoms of neuropathy associated with various etiologies. Based on such data, a multicenter double-blind, placebo-controlled, randomized trial was conducted to evaluate the effect of lamotrigine on pain and other neuropathic symptoms due to chemotherapy-induced peripheral neuropathy (CIPN).Patients with symptomatic CIPN with symptom scores of either 1) >3 on a 0-10 Numerical Rating Scale (NRS) or 2) >1 on the 0-3 the Eastern Cooperative Oncology Group (ECOG) neuropathy scale (ENS) were eligible (higher numbers corresponding to greater severity of symptoms in both scales). Patients were randomly assigned to receive lamotrigine (target dose of 300 mg/day) or placebo for 10 weeks. Endpoints were measured biweekly.In all, 131 patients were enrolled. Both groups were well matched at baseline. Over the 10-week period of the trial, the average pain scores (NRS) for the lamotrigine and placebo arms declined in both arms, with no statistically significant difference noted between the changes in the 2 groups (0.3 and 0.5 unit reduction from baseline, respectively; P = .56). Similarly, decreases in the ENS with therapy were not statistically different (0.4 and 0.3, respectively; P = .3). Changes in other subjective symptom scales were also not found to be statistically different between the 2 groups. Toxicities were mild and similar in each group.The results suggest that lamotrigine is not effective for relieving neuropathic symptoms in patients because of CIPN. Cancer 2008. � 2008 American Cancer Society. (Source: Cancer)
Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial
Given observational findings that physical activity reduces breast cancer risk, improves survival, and improves quality of life in breast cancer survivors, a need has been identified for randomized controlled trials that testthe efficacy of exercise on biological mechanisms associated with breast cancer survival. The primary aims of the Yale Exercise and Survivorship Study were to 1) determine the feasibility of recruiting breast cancer survivors into a randomized controlled trial of the effects of exercise on biological markers and/or mechanisms associated with survival, 2) compare the effectiveness of various recruitment strategies on accrual rates and baseline characteristics, and 3) report adherence to the exercise trial.Seventy-five postmenopausal breast cancer survivors self-referred into the trial or were recruited through the Connecticut Tumor Registry and randomly assigned to an exercise (n = 37) or usual-care (n = 38) group. The exercise group participated in 150 min/wk of supervised gym-based and home-based aerobic exercise for 6 months. The usual-care group was instructed to maintain current physical activity level.A total of 75 women (an accrual rate of 9.5%) were randomized to the trial. Rates of accrual were higher for women who self-referred into the study (19.8%) compared with women recruited via the cancer registry (7.6%); however, demographic, physiologic, and prognostic characteristics did not differ between the 2 recruitment strategies. On average, exercisers increased moderate- intensity to vigorous-intensity aerobic exercise by 129 minutes per week compared with 44 minutes per week among usual-care participants (P < .001). Women in the exercise-intervention group increased their average pedometer steps by 1621 steps per day compared with a decrease of 60 steps per day among women in the usual-care group (P < .01).Findings from this study will provide useful information for investigators who are conducting exercise trials in cancer populations, clinicians who are treating women diagnosed with breast cancer, and exercise professionals who are developing community-based exercise programs for cancer survivors. Cancer 2008. � 2008 American Cancer Society. (Source: Cancer)

  acupuncture typical costs guide  
 

Chinese Acupuncture An Ancient Art For A Modern Age
By Peter Wellington
Chinese acupuncture

Chinese is nothing new, it’s been with us for centuries and its popularity continues to grow in the West. Today you will find a Chinese clinic in almost every town, City or state and in the States.

Acupuncture and acupressure is considered to be a complementary medicine. Sometimes it is referred to as an alternative therapy and as such it should be used as together with thorough consultations with a qualified medical practitioner.

Men and women who have had many years of intense and thorough training in the art staff Chinese clinics. These people are true experts who use Chinese to assist the healing of many ailments and injuries.

Arthritis and other complaints related to the joints, bones and muscles are considered highly treatable with Chinese acupuncture. Many people attest to the fact that they have received considerable relief from their pain and suffering following their treatment. If you suffer from these types of complaints then you’d be well advised to seek out an acupuncturist and try it for yourself. Make sure that you see your regular doctor first however.

Chinese and Pain Relief

For a great deal of sufferers has provided a degree of pain relief that hitherto they have not enjoyed from other forms of modern painkiller drugs. Taking into account that the side effects of many of these drugs can be as uncomfortable as the pain then Chinese paints a rosy alternative.

Pain relief is not the only benefit from Chinese acupuncture. Many other complaints and ailments, common and not so common are highly treatable with the intervention of a killed practitioner. Nicotine addiction has a severe, life threatening, health-inhibiting grip on a good deal of people, both young and old. Often these folk will feel a sense of helplessness and at a loss in the face of this restricting force operating in their lives. Thankfully those who

Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage.

Related Articles

Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage.

Surg Neurol. 2008 May;69(5):441-6

Authors: Miller CM, Vespa P, Saver JL, Kidwell CS, Carmichael ST, Alger J, Frazee J, Starkman S, Liebeskind D, Nenov V, Elashoff R, Martin N

BACKGROUND: Spontaneous ICH is a devastating disease with high morbidity and mortality. Intracerebral hemorrhage lacks an effective medical or surgical treatment despite the acknowledged pathophysiologic benefits of achieved hemostasis and clot removal. Image-guided stereotactic endoscopic hematoma evacuation is a promising minimally invasive approach designed to limit operative injury and maximize hematoma removal. METHODS: A single-center randomized controlled trial was designed to assess the safety and efficacy of stereotactic hematoma evacuation compared to best medical management. Patients were randomized within 24 hours of hemorrhage in a 3:2 fashion to best medical management plus endoscopic hematoma evacuation or best medical management alone. Data were collected to assess efficacy and safety of hematoma evacuation and to identify procedural components requiring technical improvement. RESULTS: Ten patients have been enrolled and randomized to treatment. Six patients underwent endoscopic evacuation with a hematoma volume reduction of 80% +/- 13% at 24 hours post procedure. The medical arm demonstrated a hematoma enlargement of 78% +/- 142% during this same period. Rehemorrhage rates and deterioration rates were similar in the 2 groups. Mortality was 20% in the endoscopic group and 50% in the medical treatment cohort. The endoscopic technique was shown to be effective in identification and evacuation of hematomas, whereas reduction in the number of endoscopic passes and maintenance of hemostasis require further study. CONCLUSION: Image-guided stereotactic endoscopic hematoma removal is a promising minimally invasive technique that is effective in immediate hematoma evacuation. This technique deserves further investigation to determine its role in ICH management.

PMID: 18424298 [PubMed – in process]

(Source: Surgical Neurology)]></span>
Pleiotropic effects of fenretinide in neuroblastoma cell lines and multicellular tumor spheroids.

Related Articles

Pleiotropic effects of fenretinide in neuroblastoma cell lines and multicellular tumor spheroids.

Int J Oncol. 2008 May;32(5):1011-9

Authors: Cuperus R, Tytgat GA, Leen R, Brites P, Bras J, Caron HN, Van Kuilenburg AB

The efficacy and mechanism of action of fenretinide (4-HPR), a vitamin A analogue, was investigated in a panel of six neuroblastoma cell lines and multicellular tumor spheroids. The latter are three dimensional cell aggregates and as such, a model for micrometastases. In all cell lines, the production of reactive oxygen species (ROS) increased with 163-680% after 1 h of treatment with 4-HPR. In addition, a decrease of the mitochondrial membrane potential of 30-75% was observed after 4 h of incubation with 4-HPR. A 6-12-fold difference was observed between the IC50 values for cell proliferation and viability between the most sensitive (IMR32) and most resistant (NASS) cell line towards 4-HPR. Flow cytometric analysis showed an increased amount of apoptotic bodies and no cell-cycle arrest. The antioxidant Trolox completely inhibited the accumulation of 4HPR-induced ROS and prevented the 4HPR-associated cytotoxicity. In all neuroblastoma spheroids, 4-HPR induced a complete cytostasis at clinical relevant concentrations (3-10 microM). Immunohistochemical analysis of 4-HPR-treated spheroids showed a decreased staining for proliferation marker Ki-67 and an increased staining for cleaved-PARP, a marker of apoptosis. Our results suggest that 4-HPR might be a promising agent for the treatment of micrometastases and high-risk neuroblastoma.

PMID: 18425327 [PubMed – in process]

(Source: International Journal of Oncology)]>
Evaluation of a nanotechnology-based carrier for delivery of curcumin in prostate cancer cells.
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Evaluation of a nanotechnology-based carrier for delivery of curcumin in prostate cancer cells.

Int J Oncol. 2008 May;32(5):1119-23

Authors: Thangapazham RL, Puri A, Tele S, Blumenthal R, Maheshwari RK

We have initiated studies to enhance targeted delivery of an anticancer agent, curcumin, for prostate cancer treatment by incorporating this agent into the liposomes (nanodelivery vehicles primarily composed of phospholipids) coated with prostate membrane specific antigen specific antibodies. We prepared curcumin-loaded liposomes of various lipid compositions by sonication at an average size of 100-150 nm. Un-entrapped curcumin was removed by size exclusion chromatography. Data show that curcumin preferentially partitioned into liposomes prepared from dimyristoyl phosphatidyl choline (DMPC) and cholesterol among the various compositions tested. The anti-proliferative activity of liposomal curcumin was studied using two human prostate cancer cell lines (LNCaP and C4-2B) by a tetrazolium dye-based (MTT) assay. Treatment of cells with liposomal curcumin (5-10 microM) for 24-48 h at 37 degrees C resulted in at least 70-80% inhibition of cellular proliferation without affecting their viability. On the other hand, free curcumin exhibited similar inhibition only at 10-fold higher doses (>50 microM). We also observed that LNCaP cells were relatively more sensitive to liposomal curcumin mediated block of cellular proliferation than C4-2B cells. We are currently developing liposome formulations with targeting ability to further improve the efficacy of curcumin in vivo.

PMID: 18425340 [PubMed – in process]

(Source: International Journal of Oncology)]>
Prevention of amyloid beta-induced memory impairment by fluvastatin, associated with the decrease in amyloid beta accumulation and oxidative stressin amyloid beta injection mouse model.
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Prevention of amyloid beta-induced memory impairment by fluvastatin, associated with the decrease in amyloid beta accumulation and oxidative stressin amyloid beta injection mouse model.

Int J Mol Med. 2008 May;21(5):531-7

Authors: Kurinami H, Sato N, Shinohara M, Takeuchi D, Takeda S, Shimamura M, Ogihara T, Morishita R

Alzheimer’s disease (AD), the most common cause of dementia in the elderly, is characterized by amyloid beta (Abeta)-containing plaques and neurofibrillary tangles, and synaptic and neuronal loss, along with progressive cognitive impairment. Although growing evidence suggests the beneficial effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on AD, this notion is still controversial. To evaluate the efficacy of statins for Abeta-induced cognitive impairment, we employed an Abeta injection model. Using this model, the present study demonstrated that pretreatment with fluvastatin, but not post-treatment just after Abeta exposure, prevented Abeta-induced memory impairment. We also observed that fluvastatin significantly decreased Abeta accumulation and oxidative stress after Abeta injection. Mice treated with simvastatin, but not fluvastatin, did not demonstrate the prevention of Abeta-induced memory impairment, and showed no significant decrease in oxidative stress. More importantly, fluvastatin significantly prevented the loss of neurons in the basal forebrain induced by Abeta. Overall, the present study demonstrated that fluvastatin significantly prevented memory impairment induced by Abeta. The beneficial effects of fluvastatin might be explained by the preservation of neurons through a significant decrease in Abeta accumulation and oxidative stress. In clinical practice, the timing of the start of fluvastatin treatment might be critical in achieving a beneficial effect on cognitive function.

PMID: 18425343 [PubMed – in process]

(Source: International Journal of Molecular Medicine)]>
Reovirus activates human dendritic cells to promote innate antitumor immunity.
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Reovirus Activates Human Dendritic Cells to Promote Innate Antitumor Immunity.

J Immunol. 2008 May 1;180(9):6018-6026

Authors: Errington F, Steele L, Prestwich R, Harrington KJ, Pandha HS, Vidal L, de Bono J, Selby P, Coffey M, Vile R, Melcher A

Oncolytic viruses can exert their antitumor activity via direct oncolysis or activation of antitumor immunity. Although reovirus is currently under clinical investigation for the treatment of localized or disseminated cancer, any potential immune contribution to its efficacy has not been addressed. This is the first study to investigate the ability of reovirus to activate human dendritic cells (DC), key regulators of both innate and adaptive immune responses. Reovirus induced DC maturation and stimulated the production of the proinflammatory cytokines IFN-alpha, TNF-alpha, IL-12p70, and IL-6. Activation of DC by reovirus was not dependent on viral replication, while cytokine production (but not phenotypic maturation) was inhibited by blockade of PKR and NF-kappaB signaling. Upon coculture with autologous NK cells, reovirus-activated DC up-regulated IFN-gamma production and increased NK cytolytic activity. Moreover, short-term coculture of reovirus-activated DC with autologous T cells also enhanced T cell cytokine secretion (IL-2 and IFN-gamma) and induced non-Ag restricted tumor cell killing. These data demonstrate for the first time that reovirus directly activates human DC and that reovirus-activated DC stimulate innate killing by not only NK cells, but also T cells, suggesting a novel potential role for T cells in oncolytic virus-induced local tumor cell death. Hence reovirus recognition by DC may trigger innate effector mechanisms to complement the virus’s direct cytotoxicity, potentially enhancing the efficacy of reovirus as a therapeutic agent.

PMID: 18424722 [PubMed – as supplied by publisher]

(Source: Journal of Immunology)]>
Endocrine manipulation in male infertility.
Related Articles

Endocrine Manipulation in Male Infertility.

Urol Clin North Am. 2008 May;35(2):303-318

Authors: Kim HH, Schlegel PN

Endocrine therapy for male infertility is broadly categorized as specific or nonspecific therapy. Although uncommon, primary endocrine diagnoses in infertile men are amenable to targeted therapy. The efficacy of empiric endocrine therapy for idiopathic male infertility, however, has not been demonstrated conclusively by clinical trials. With better understanding of the underlying pathophysiology of idiopathic male infertility, careful evaluation of endocrine therapy in well-selected treatment groups and well-designed randomized, controlled trials is warranted. Although empiric endocrine therapy for idiopathic male infertility has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, perhaps as combination therapy.

PMID: 18423250 [PubMed – as supplied by publisher]

(Source: The Urologic Clinics of North America)]>
Assessing diagnostic confidence a comparative review of analytical methods.
Related Articles

Assessing diagnostic confidence a comparative review of analytical methods.

Acad Radiol. 2008 May;15(5):584-92

Authors: Ng CS, Palmer CR

RATIONALE AND OBJECTIVES: The ability of a test to influence diagnostic confidence is used as a measure of its efficacy. Our aim was to compare analytic methods that evaluate changes in confidence. MATERIALS AND METHODS: The approaches compared were “basic,” “retained diagnoses,” “Omary,” “Tsushima,” and “score-based” methods. For illustration, data from a clinical study assessing changes in diagnostic confidence (0%-100%) before and after abdominopelvic computed tomography (CT) in patients with acute abdominal pain were used. RESULTS: The basic, retained diagnoses and Omary methods all ignore whether the test yields a correct diagnosis (confident, but incorrect, diagnoses are regarded positively). Although the Tsushima method takes some account of diagnostic accuracy, all misdiagnoses are considered equal. The score-based method addresses some of the fundamental limitations in the other analyticl methods, such as diagnostic accuracy and the varying nature of different misdiagnoses. In the case study, mean (SD) diagnostic confidence for the cohort as a whole (n = 62) increased following CT: 50.7% (20.8%) to 73.2% (20.9%). Pretest diagnoses were changed following CT in 43% (27 of 62) of patients. Pretest diagnoses proved to be incorrect in 52% (32 of 62), and post-test diagnoses incorrect in as many as 19% (12 of 62) of patients. All five analytic methods indicated a positive contribution for CT (all P

PMID: 18423315 [PubMed – in process]

(Source: Academic Radiology)]>
Critique of the transitional year internship and its relationship to radiology residency.
Related Articles

Critique of the transitional year internship and its relationship to radiology residency.

Acad Radiol. 2008 May;15(5):662-8

Authors: Baker SR, Tilak GS, Thakur U

RATIONALE AND OBJECTIVES: The purpose of the study is to determine if transitional year program (TYP) requirements foster realization of standards of excellence and clinical relevance for future radiologists and to explore demographic and economic factors pertinent to TYPs. MATERIALS AND METHODS: A list of accredited TYPs were obtained from the American Medical Association’s Graduate Medical Education (ACGME) Directory 2006-2007. Specialty distribution of TYP graduates was examined from statistics provided by the ACGME, and data from the 2007 Main Residency Match was analyzed. Data derived from a concurrent survey of the perception of the value of internship sent to all current radiology residents and fellows was assessed. The institutional costs of employing TYP interns versus physician assistants were also calculated. RESULTS: Forty-one of the 125 TYPs lack residencies in internal medicine (IM), general surgery (GS), or both, and approximately two-third of these lack full medical school affiliation. The interns who will graduate from these 41 programs account for 103 of the 1,128 radiology residents in their post-graduate year 2. Despite the longest elective time offered in TYPs compared to conventional preliminary programs, current radiology trainees who had participated in preliminary IM or GS internships were more satisfied compared to trainees completing TYPs. CONCLUSIONS: The requirements of the transitional internship and compliance with them need to be carefully assessed to determine their efficacy. Despite the strong economic impetus for hiring TYP interns, the availability of open slots in existing preliminary programs in IM and GS, coupled with radiology residents’ greater level of satisfaction with traditional over transitional internships, makes the existence of TYPs less compelling.

PMID: 18423324 [PubMed – in process]

(Source: Academic Radiology)]>
Noninvasive system shows efficacy in delivering high dose rate brachytherapy
The efficacy of the CyberKnife robotic radiosurgery system in delivering complex, high dose rate (HDR)
brachytherapy to the prostate noninvasively without the need for hospitalization or anesthesia has been reported in
the International Journal of Radiation Oncology Biology Physics (2008; 70:1588-97). (Source: UrologyTimes – Prostate Cancer)

Sharing bed with wife helps men’s sleep apnea rx
(Source: Health Behavior News Digest)
First method for testing, assessing drug treatments for chagas’ disease identified
Scientists have identified for the first time a sensitive method for testing and assessing the efficacy of treatments for Chagas’ disease. The study could lead to new treatments for long-term sufferers of a disease that can be fatal. (Source: ScienceDaily Headlines)
Director’s testimony: fiscal year 2009 budget request
I am pleased to present the President’s Fiscal Year (FY) budget request for the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health. The FY 2009 budget includes 21,695,000, which is 18,000 more than the comparable FY 2008 appropriation of 21,577,000.

The public’s concept of health is broader than preventing and treating disease. Increasingly, Americans are using strategies that they can employ themselves to improve their health, maintain wellness, and improve quality of life. As part of this participatory approach to health, millions of people are using complementary and alternative medicine (CAM). Many of the leading U.S. medical institutions now offer integrative medicine services. These programs include personalized CAM interventions such as yoga, meditation, massage, and acupuncture. However, we know relatively little about the true potential of CAM to improve health and well being or to preempt disease, or about how best to use most CAM modalities. We also need to understand how CAM practices interact with other therapies and whether they are safe.

Given this consumer-driven call for better approaches to improved health and wellness, the medical research community has begun to explore promising CAM approaches and develop the scientific evidence base for CAM modalities that can be integrated as part of comprehensive health care. Using proven scientific methods and rigorous standards, NCCAM is building the research enterprise and the evidence base to better understand CAM. Through scientific investigation, research training programs, and outreach activities, NCCAM’s efforts will support the rational integration of proven CAM approaches with conventional medicine. (Source: NCCAM Featured Content)
Chelsea announces publication of clinical autonomic research
supplement focusing on neurogenic orthostatic hypotension

Chelsea Announces Publication of Clinical Autonomic Research
Supplement Focusing On Neurogenic Orthostatic Hypotension
Publication Highlights Efficacy of Droxidopa in Key European and
U.S. Trials and Provides Insight Into Initial… (Source: Drugs.com – Clinical Trials)

Long-term effects of pegvisomant in patients with acromegaly
Some patients with acromegaly cannot attain biochemical remission despite various therapeutic approaches. Pegvisomant suppresses insulin-like growth factor 1 production. The efficacy and related risks and benefits of this therapy for acromegaly are described. Nature Clinical Practice Endocrinology & Metabolism (Source: Medscape FamilyMedicine Headlines)
Curcumin restores corticosteroid function
Curcumin, a dietary polyphenol most commonly found in curry, restores oxidative-stress-impaired histone deacetylase-2 activity and corticosteroid efficacy in monocytes, researchers report. (Source: MedWire News – Respiratory)
Re: effect of short-term hospitalization on functional capacity in patients not restricted to bed.
Page: 425DOI: 10.1097/PHM.0b013e31816dd045Authors: Kortebein, Patrick MD (Source: American Journal of Physical Medicine & Rehabilitation)
Re: effect of short-term hospitalization on functional capacity in patients not restricted to bed.
Page: 425DOI: 10.1097/PHM.0b013e31816dda18Authors: Carvalho, Celso R. F. MD (Source: American Journal of Physical Medicine & Rehabilitation)
Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach.
Page: 197DOI: 10.1097/SLE.0b013e318168dda4Authors: Kim, Jung Han MD *; Choi, Young Jin MD *; Kim, Ji A. MD *; Gil, Won Ho MD *; Nam, Seok Jin MD, PhD *; Oh, Young Lyun MD +; Yang, Jung-Hyun MD, PhD, FACS * (Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques)
Safety and efficacy of prk and lasik in pediatric patients.
Page: 193DOI: 10.1097/IIO.0b013e31816923d9Authors: Qian, Ying MD, PhD; Pineda, Roberto MD (Source: International Ophthalmology Clinics)
48-week pooled data from motivate 1 and 2 confirm durable efficacy, safety of maraviroc in treatment-experienced patients with r5 hiv-1
In treatment-experienced patients infected with R5 HIV-1, maraviroc plus OBR provided greater virologic, immunologic efficacy over 48 weeks of follow-up vs OBR alone (Source: Clinical Care Options HIV)
Interim analysis of phase i/ii study of rexin-g confirms efficacy with no dose limiting toxicity in metastatic pancreatic cancer
Epeius Biotechnologies Corporation announced that Interim Analysis of an on-going Phase I/II study of Rexin-G for pancreatic cancer confirmed Rexin-G’s anti-tumor activity with no major toxicity in patients with metastatic chemotherapy-resistant pancreatic cancer. The clinical trial design includes 5 escalating doses of intravenous Rexin-G ranging from 1 x 10e11 cfu twice a week to 4 x 10e11 cfu three times a week for 4 weeks. (Source: Cancer / Oncology News From Medical News Today)
Oral cephalexin for acne vulgaris: clinical experience with 93 patients
Pediatric Dermatology, Volume 25, Issue 2, Page 179-183, March/April 2008.

Abstract:�For patients who fail traditional acne therapy or experience side effects, other treatments are needed. Cephalexin has been noted to be efficacious in some instances. This study aimed to assess the therapeutic efficacy of cephalexin for acne. A … (Source: Pediatric Dermatology)
Length of stay and associated costs of obesity related hospital admissions in ireland
Background:
Obesity is the cause of other chronic diseases, psychological problems, obesity shortens the lifespan and puts strain on health systems. The risk associated with childhood obesity in particular, which will accelerate the development of adult morbidity and mortality, has been identified as an emerging public health problem.
Methods:
To estimate the length of stay and associated hospital costs for obesity related illnesses, a cost of illness study was set up. All discharges from acute hospitals in the Republic of Ireland from 1997 to 2004 with a principal or secondary diagnostic code for obesity for all children from 6 to 18 years of age and for adults were collected.
A discharge frequency was calculated by dividing obesity related discharges by the total number of diagnoses (principal and secondary) for each year. The hospital costs related to obesity was calculated based on the total number of days care.
Results:
The discharge frequency of obesity related conditions increased from 1.14% in 1997 to 1.49% in 2004 for adults and from 0.81% to 1.37% for children. The relative length of stay (number of days in care for obesity related conditions per 1000 days of hospital care given) increased from 1.47 in 1997 to 4.16 in 2004 for children and from 3.68 in 1997 to 6.74 in 2004 for adults.
Based on the 2001 figures for cost per inpatient bed day, the annual hospital cost was calculated to be 4.4 Euromillion in 1997, increasing to 13.3 Euromillion in 2004. At a 20% variable hospital cost the cost ranges from 0.9 Euromillion in 1997 to 2.7 Euromillion in 2004; a 200% increase.
Conclusions:
The annual increase in the proportion of hospital discharges related to obesity is alarming. This increase is related to a significant increase in economic costs. This paper emphasises the need for action at an early stage of life. Health promotion and primary prevention of obesity should be high on the political agenda. (Source: BioMed Central)

Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: a protocol for a randomised double-blind placebo- controlled trial.
Background:
Major shoulder surgery often results in severe post-operative pain and a variety of interventions have been developed in an attempt to address this. The continuous slow infusion of a local anaesthetic directly into the operative site has recently gained popularity but it is expensive and as yet there is little conclusive evidence that it provides additional benefits over other methods of post-operative pain management.
Methods:
This will be a randomised, placebo-controlled trial involving 158 participants. Following diagnostic arthroscopy, all participants will undergo either arthroscopic subacromial decompression with or without rotator cuff repair, by a single surgeon. Participants, the surgeon, nurses caring for the patients and outcome assessors will be blinded to treatment allocation. A pre-incision bolus injection of 10mls of ropivacaine 1% into the shoulder and an intra-operative intravenous bolus of parecoxib 40mg.will be given. Using concealed allocation participants will be randomly assigned to active treatment (local anaesthetic ropivacaine 0.75%) or placebo (normal saline) administered continuously into the subacromial space by an elastometric pump at 5 mls per hour post-operatively. Patient controlled opioid analgesia and oral analgesics will be available for breakthrough pain. Outcome assessment will be at 15, 30 and 60 minutes, 2, 4, 8, 12, 18 and 24 hours, and 2 or 4 months for decompression or decompression plus repair respectively.
The primary end point will be the average pain at rest over the first 12-hour post-operative period, on a verbal analogue pain score from 0 to 10.. Secondary end points will be average pain at rest over the second 12-hour post-operative period, maximal pain at rest over the first and second 12-hour periods, amount of rescue medication used, length of inpatient time following decompression, and decompression plus repair, and the incidence of post-operative adhesive capsulitis up to 2 or 4 months following decompression or decompression plus repair respectively.DiscussionThe results of this trial will contribute to evidence-based recommendations for the effectiveness of pain management modalities following arthroscopic rotator cuff surgery. If the local anaesthetic pain-buster provides no additional benefits over placebo then valuable resources can be put to better use in other ways. (Source: BMC Musculoskeletal Disorders)

A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis
Background:
Allergies cause a considerable burden to both sufferers and the National Health Service. There is growing interest in acupuncture as a treatment for a range of conditions. Since acupuncture may modulate the immune system it could be a useful treatment for allergic rhinitis (AR) sufferers. We therefore assessed the evidence for the clinical effectiveness of acupuncture in patients with AR by performing a systematic review of the literature.
Methods:
Searches (to 2007) were conducted in all major databases for randomised controlled trials (RCTs) evaluating the clinical effectiveness of acupuncture in the treatment of AR. No limits were placed on language. Studies were included if they compared acupuncture to a sham or inactive acupuncture treatment (placebo) with or without standard care. Meta-analysis was performed where feasible.
Results:
Seven relevant RCTs were included after screening and application of inclusion and exclusion criteria. The trials were generally of poor quality as assessed by a modified Jadad scale, with the exception of two studies which scored highly. A wide variety of outcomes was measured but most assessed symptom severity on a visual analogue scale. A meta-analysis failed to show any summary benefits of acupuncture treatment for symptom severity scores or serum IgE measures which could not have been accounted for by chance alone. Acupuncture was not associated with any additional adverse events in the trials.
Conclusion:
There is currently insufficient evidence to support or refute the use of acupuncture in patients with AR. A large well conducted RCT, which overcomes identified methodological problems in the existing RCTs, would be required to resolve this question. (Source: BMC Complementary and Alternative Medicine)

Mutagenicity of 42 chemicals in salmonella
The mutagenicity results and data for 42 chemicals are reported. All chemicals were tested using the Salmonella/microsome assay preincubation protocol, and four were also tested using vapor phase exposure in a desiccator. These comprise the chemicals studied in the update of the National Toxicology Program’s evaluation of the efficacy of in vitro short-term tests for detecting carcinogens and noncarcinogens. (Source: Environmental and Molecular Mutagenesis)
[hepatobiliary imaging] ct laparoscopy for detecting small superficial metastatic lesions of the liver surface: initial experience
OBJECTIVE. The purpose of this study was to determine the efficacy
of CT laparoscopy in the detection of superficial metastasis of the liver
surface.
SUBJECTS AND METHODS. From April 1, 2007, to July 1, 2007, a total
of 34 consecutively registered patients (19 men, 15 women; median age, 55
years) with various intraabdominal malignant tumors underwent preoperative CT
and composed the study population. All patients underwent superparamagnetic
iron oxide&ndash;enhanced MRI and portal phase contrast-enhanced 64-MDCT,
including CT laparoscopy. CT laparoscopy is a form of volume-rendering 3D
imaging of the liver that depicts the liver surface in detail.
RESULTS. Among 23 patients who underwent surgery for management of a
primary tumor, four patients had seven superficial metastatic lesions of the
liver surface. None of these lesions had been detected with preoperative axial
CT or superparamagnetic iron oxide&ndash;enhanced MRI. In contrast, CT
laparoscopy revealed four of seven lesions in four patients. On a
lesion-by-lesion basis, the sensitivity was 57%, the positive predictive value
was 100%, and the accuracy was 57%.
CONCLUSION. Our initial experience proves that CT laparoscopy is a
promising method for detecting small superficial metastatic lesions of the
liver surface. The findings can influence decisions regarding tumor
resectability. (Source: American Journal of Roentgenology)

[forensic radiology] postmortem whole-body ct angiography: evaluation of two contrast media solutions
OBJECTIVE. The objective of our study was to establish a
standardized procedure for postmortem whole-body CT-based angiography with
lipophilic and hydrophilic contrast media solutions and to compare the results
of these two methods.
MATERIALS AND METHODS. Minimally invasive postmortem CT angiography
was performed on 10 human cadavers via access to the femoral blood vessels.
Separate perfusion of the arterial and venous systems was established with a
modified heart&ndash;lung machine using a mixture of an oily contrast medium
and paraffin (five cases) and a mixture of a water-soluble contrast medium
with polyethylene glycol (PEG) 200 in the other five cases. Imaging was
executed with an MDCT scanner.
RESULTS. The minimally invasive femoral approach to the vascular
system provided a good depiction of lesions of the complete vascular system
down to the level of the small supplying vessels. Because of the enhancement
of well-vascularized tissues, angiography with the PEG-mixed contrast medium
allowed the detection of tissue lesions and the depiction of vascular
abnormalities such as pulmonary embolisms or ruptures of the vessel wall.
CONCLUSION. The angiographic method with a water-soluble contrast
medium and PEG as a contrast-agent dissolver showed a clearly superior quality
due to the lack of extravasation through the gastrointestinal vascular bed and
the enhancement of soft tissues (cerebral cortex, myocardium, and parenchymal
abdominal organs). The diagnostic possibilities of these findings in cases of
antemortem ischemia of these tissues are not yet fully understood. (Source: American Journal of Roentgenology)

Could laser surgery finally put the curse of snoring to bed?
ANYONE who has ever shared a bed with a snorer knows the torture of sleepless nights and the arguments that can follow. Now surgeons hope a revolutionary laser technique could (Source: Scotsman.com News – Health)
Raloxifene safely increases bmd in women with chronic kidney disease?
According to the results of a subgroup analysis, treatment with raloxifene safely increases bone mineral density (BMD) in postmenopausal women with chronic kidney disease and cuts the risk of vertebral fractures.

While patients with chronic renal disease are known to be at increased risk for bone loss, women with elevated creatinine levels are usually excluded from trials of osteoporosis drugs, according to the report in the April 9th online issue of the Journal of the American Society of Nephrology.

The authors note that the majority of clinical trials evaluating pharmacological therapies in preventing fractures in postmenopausal women have excluded those with renal impairment. It is therefore uncertain whether the beneficial effects of osteoporosis therapy extend to those with kidney disease, and whether such therapies are safe in this patient population. They therefore used data from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial to examine the efficacy and safety of raloxifene in risk subgroups defined at baseline according to presence and severity of chronic kidney disease (CKD).

MORE was a multicentre, international placebo controlled trial of the effects of raloxifene on BMD and fracture incidence in postmenopausal women over three years (n=7316). Baseline serum creatinine values were used to assign participants to a category of creatinine clearance (calculated using Cockcroft-Gault formula). Among the cohort, 1480 (20%) had a CrCl of &lt;45 ml/min, 3493 (48%) had a CrCl of 45 to 59 ml/min, and 2343 (32%) had CrCl =60 ml/min. Among the women with a CrCl &lt;45 ml/min, only 55 had a CrCl &lt;30 ml/min, and the lowest was CrCl 20.0 ml/min. There were several differences in baseline characteristics across categories of CrCl; e.g. women with lower CrCl were more likely to be older and more years postmenopausal; to have a lower body mass index (BMI); to have a lower baseline BMD and to have prevalent fractures. BMD was measured at baseline and then annually with dual x-ray absorptiometry (DEXA).

The main findings were as follows:

? In the placebo group, a lower CrCl at baseline correlated with higher annual losses of BMD at the femoral neck, but this trend did not reach statistical significance (p=0.09). In the raloxifene group, lower CrCl at baseline correlated with greater increases in the femoral neck BMD (P=0.01 for trend).

? Compared with placebo, the effect of raloxifene on increasing femoral neck BMD was 1.0% per year among women with a CrCl &lt;45 ml/min, 0.7% per year among women with a CrCl of 45 to 59 ml/min, and 0.6% per year among women with a CrCl =60 ml/min (P &lt;0.001 for all comparisons between pooled raloxifene treatment group and placebo group).

? Raloxifene was associated with an overall decrease in the incidence of vertebral fractures (odds ratio [OR] 0.57; 95% CI 0.47 to 0.69), and there was no evidence that this effect differed according to CrCl at baseline. In addition, the effect of raloxifene on rate of change in spine BMD did not differ according to renal function.

? Women with reduced kidney function overall were more likely to experience one or more serious adverse effects and to discontinue the study permanently as a result of an adverse event; however, the rates of adverse events were similar between the raloxifene and placebo groups within each category of kidney function.

The authors conclude that their results support the use of raloxifene as a safe and effective means to increase BMD and prevent vertebral fractures in postmenopausal women with osteoporosis and compromised kidney function. [Editor?s note: as this was a subgroup analysis, the findings need to be confirmed in a prospective trial adequately powered to test this]. (Source: NeLM Headline News)
Cochrane review: clobazam as an add-on in the management of refractory epilepsy
According to the findings of a systematic review conducted by the Cochrane Collaboration, clobazam may reduce seizure frequency as an add-on treatment, and may be most effective in partial onset seizures, however further study is required to determine who will best benefit and over what time-frame.

The authors note that up to 30% of patients with epilepsy continue to suffer from seizures, despite multiple combinations of antiepileptic drugs (AEDs). Although the 1,4-benzodiazepines have a clear role in the acute management of epileptic seizures, they are associated with a number of disadvantages, including short half-life (lorazepam) and accumulation in fat stores (diazepam). Clobazam is a 1,5-benzodiazepine that has long been used as an adjunct to reduce seizure frequency; it has a broader spectrum of antiepileptic activity and a long half life (active metabolite ? 35-133 hours). Although there have been concerns over its long-term use (e.g. sedation and development of tolerance), the data to support these are limited and come from open, unrandomised trials, with widely ranging variation in the definition of ‘tolerance’. The aim of this review was to examine the efficacy of clobazam as an add-on treatment in the management of refractory cases of epilepsy, of partial onset with or without secondary generalisation and generalised tonic clonic seizures, in both adults and children, with regard to seizure reduction, side effects and tolerance.

A total of four randomised, double-blind, placebo-controlled cross-over studies meeting the inclusion criteria were included (Total n=196), however it was not possible to carry out a meta-analysis due to differences between them in terms of methodology and outcome measures. Only two of the studies reported a 50% or greater seizure reduction compared to placebo as an outcome measure; 57.7% and 52.4%. The remaining two studies did not report this outcome, although one reported that 40% achieved a 75% or more reduction in seizure frequency. Side effects were only described in two of the studies, reportedly present in 36% and 85% of patients.

For a description of each of the studies, including data on withdrawal, efficacy, side effects and quality of life, please see the full publication at the link above. The authors say that their results suggest that clobazam as an add-on therapy reduces seizure frequency for drug refractory partial epilepsy, but that there are limited and inconclusive data for generalised epilepsy. (Source: NeLM Headline News)
Cochrane review: recombinant interferon beta or glatiramer acetate for delaying conversion of the first demyelinating event to multiple sclerosis
According to the authors of a Cochrane systematic review, early treatment with interferon (IFN) beta delays the conversion from clinically isolated syndromes (CIS) to clinically definite multiple sclerosis (CDMS), over two years of follow up.

Epidemiological studies have shown that CIS suggestive of demyelinating events carry a high risk to convert to CDMS, particularly if the MRI scan has typical white matter lesions. The reviewers carried out a systematic review of the literature to identify all randomised trials of adequate quality comparing either IFN beta or glatiramer acetate (GA) treatment to placebo in patients with CIS, although none for the latter were located. The three trials meeting the inclusion criteria assessed the following (total n=1160):

? IFN beta 1a 30 mcg weekly by intramuscular injection (CHAMPS trial)
? IFN beta 1a 22 mcg weekly by subcutaneous injection (ETOMS)
? IFN beta 1 b 250 mcg every other day by subcutaneous injection (BENEFIT)

As the primary endpoints used differed slightly, each trial was analysed separately in addition to the meta-analysis. The main results were as follows (per-protocol):

? CHAMPS: at one year the risk of conversion was 16% in participants receiving IFN and 24% in those receiving placebo (OR 0.59, 95% CI 0.34 to 1.01, p=0.05). The conversion to CDMS would be prevented in 8 (95 % CI 0 to 17) of 100 CIS patients during the first year of IFN treatment.

? ETOMS: at one year the risk of conversion was 25% in participants receiving IFN and 37% in those receiving placebo (OR 0.57, 95% CI 0.35 to 0.94, p=0.03) and at two years the risk was 34.6% and 46%, respectively (OR 0.62, 95% CI 0.39 – 0.99, p=0.05).

? BENEFIT: at one year the risk of conversion was 18% in participants receiving IFN and 31% in those receiving placebo (OR 0.48, 95% CI 0.31 to 0.74, p=0.0009) and at two years the risk was 26% and 44%, respectively (OR 0.44, 95% CI 0.30 to 0.66, p&lt;0.0001)

? META-ANALYSES: at one year the risk of conversion was 19% in patients receiving IFN and 30% in those receiving placebo (pooled OR of 0.53, 95% CI 0.40 to 0.71, p&lt;0.0001). The results show that the conversion to CDMS would be delayed for 12 months in 11 (95 % CI 6 to 16) of 100 CIS patients during the first year of IFN treatment. At two years, the risk of conversion was 29% in patients receiving IFN and 45% in those receiving placebo (pooled OR of 0.52, 95% CI 0.38 to 0.70 p&lt; 0.0001).

The authors note that the interpretation of these results may be limited due to some quality issues, e.g. the ETOMS trial did not indicate whether the investigators were blinded to treatment, and the number of patients in the CHAMPS study lost to follow-up during the second year of study was quite high (around 40%). As patients had some clinical heterogeneity (length of follow-up, clinical findings of initial attack), they suggest that it could be useful for clinical practice to further analyse the efficacy of IFN beta treatment in different patient subgroups. (Source: NeLM Headline News)
Herpes zoster vaccine acts by boosting virus-specific immune response
The proven efficacy of a high-potency live-attenuated varicella-zoster virus (VZV) vaccine is based on its ability to boost VZV-specific cell-mediated immunity and VZV antibody levels. Reuters Health Information (Source: Medscape Infectious Diseases Headlines)
Interim analysis of phase i/ii study of rexin-g confirms efficacy
with no dose limiting toxicity in metastatic pancreatic cancer;
second phase opens with higher dose regimens

SAN MARINO, Calif., April 21, 2008 (SEND2PRESS NEWSWIRE) —
Epeius Biotechnologies Corporation announced today that Interim
Analysis of an on-going Phase I/II study of Rexin-G for pancreatic
cancer confirmed Rexin-G’s anti-tumor activity with no… (Source: Drugs.com – Clinical Trials)

Interim analysis of phase i/ii study of rexin-g confirms efficacy
with no dose limiting toxicity in metastatic pancreatic cancer

Second Phase Opens With Higher Dose Regimens
SAN MARINO, Calif., April 21, 2008 /PRNewswire/ — Epeius
Biotechnologies Corporation announced today that Interim Analysis
of an on-going Phase I/II study of Rexin-G for pancreatic cancer
confirmed… (Source: Drugs.com – Clinical Trials)

Development and efficacy of nxy-059 for the treatment of acute ischemic stroke
Future Neurology , May 2008, Vol. 3, No. 3, Pages 229-240.

NXY-059 is a neuroprotective compound that prevents ischemic damage by trapping free radicals. Preclinical animal stroke models demonstrated that the agent is able to reduce histological damage and improve behavioral outcome. Phase�II studies showed that … (Source: Future Neurology)
Mental health page from cam sl acupuncture evidence update 2008
Systematic reviews on acupuncture and anxiety or insomnia, as part of the Complementary and Alternative Medicine specialist library’s Acupuncture Evidence Update. (Source: Mental Health Specialist Library Newsfeed)
Uganda: is uganda safe from india’s fake drugs?
The Economist (London) of February 23 indirectly touched on a subject that has long troubled me: the efficacy of drugs manufactured in India. In an article about India’s fake doctors titled ‘Quackdown’, The Economist revealed that India has more fake doctors than genuine ones. (Source: AllAfrica News: Health and Medicine)
Insert therapeutics to initiate a multinational phase ii clinical trial of lead drug candidate it-101 in ovarian cancer
Insert Therapeutics, Inc., a majority owned subsidiary of Arrowhead Research Corporation (ARWR), announced that it has filed with the U.S. Food and Drug Administration to initiate a Phase II clinical trial evaluating the safety and efficacy of its drug candidate IT-101 in patients with ovarian cancer. In women who receive a 2nd course of chemotherapy, nearly 75% will achieve some degree of disease stabilization. (Source: Cancer / Oncology News From Medical News Today)
Memorial hospital marks 50 years with er expansion
Mark Turner took the reins at Memorial Hospital in Belleville in August of 2006, just the third president to lead the 313-bed hospital, which is celebrating its 50th anniversary this year. He took on the top spot at Memorial Hospital, which had $220 million in 2007 revenue, after the retirement of Harry Maier. (Source: bizjournals.com Health Care:Hospitals headlines)
Endoscopic resection of hypothalamic hamartomas for refractory symptomatic epilepsy
Background: Hypothalamic hamartomas (HHs), rare developmental abnormalities of the inferior hypothalamus, often cause refractory, symptomatic, mixed epilepsy, including gelastic seizures. We present 37 patients with HH who underwent transcortical transventricular endoscopic resection.
Methods: Between October 2003 and April 2005, 42 consecutive patients with refractory epilepsy who underwent endoscopic resection of HH were studied prospectively. The endoscope was held by an articulated pneumatic arm and tracked with a frameless stereotactic neuronavigation system. Data collection and follow-up were performed by personal interview. Five patients were excluded. The remaining 37 patients (22 males, 15 females; median age 11.8 years; range 8 months to 55 years) had frequent and usually multiple types of seizures.
Results: Postoperative MRI confirmed 100% resection of the HH from the hypothalamus in 12 patients. At last follow-up (median 21 months; range 13&ndash;28 months), 18 (48.6%) patients were seizure free. Seizures were reduced more than 90% in 26 patients (70.3%) and by 50% to 90% in 8 patients (21.6%). Overall, the mean postoperative stay was shorter in the endoscopic patients compared with our previously reported patients who underwent transcallosal resection (mean 4.1 days vs 7.7 days, respectively; p = 0.0006). The main complications were permanent short-term memory loss in 3 patients and small thalamic infarcts in 11 patients (asymptomatic in 9).
Conclusions: Endoscopic resection of hypothalamic hamartoma (HH) is a safe and effective treatment for seizures. Its efficacy seems to be comparable to that of transcallosal resection of HH, but postoperative recovery time is significantly shorter. (Source: Neurology)

[original articles] b cell depletion therapy for 19 patients with refractory systemic lupus erythematosus
Objective:
B cell dysregulation is involved in the development of childhood-onset systemic lupus erythematosus (SLE). The safety and efficacy of B cell depletion therapy is evaluated in the the largest series of children to be presented in the literature.

Methods:
19 children (89% female) with SLE, aged 6&ndash;16 (median 14) years, treated with rituximab in a single centre were retrospectively reviewed. The British Isles Lupus Assessment Group (BILAG) index and biochemical, haematological and immunological parameters were evaluated before and after treatment, with the primary outcome assessed as normal results. Rituximab therapy was used for acute life- or organ-threatening symptoms or symptoms that had not responded to standard treatment. The range of symptoms included lupus nephritis, cerebral lupus and severe general symptoms. Rituximab 750 mg/m2 was given intravenously twice, usually within a 2-week period. Patients were followed up for 6&ndash;38 (median 20) months.

Results:
Rapid reduction of SLE disease activity was observed within the first month, represented by a reduction of BILAG scores (14 to 6, p&lt;0.005) and an improvement in renal function (estimated glomerular filtration rate of 54 to 68 ml/min/1.73 m2, p = 0.07), immunological (complement C3: 0.46 to 0.83 g/l, p = 0.02) and haematological (haemoglobin: 9.7 to 10.3 g/dl, p = 0.04) parameters. No serious side effects were observed, except for herpes zoster in five cases.

Conclusion:
In our cohort of children, rituximab was safe and effective when used in combination with standard immunosuppressive agents. Randomised controlled studies are needed to further evaluate the safety and efficacy of rituximab therapy. (Source: Archives of Disease in Childhood)
Livelihood, poverty and morbidity: a study on health and socio-economic status of the tribal population in orissa
The tribals of the Orissa not only deserve a sustainable form of livelihood, but also proper access to adequate health care facilities, as poverty and morbidity go together to cause vicious circle. Because of a higher incidence of poverty, tribals fail to acquire adequate calories, nutrition and vitamins to keep them immune from various diseases. On the other hand, poverty further diminishes their earning capability due to the affliction of various seasonal and endemic diseases round the year. Hence, for the capacity building of poor tribals to enable them to come out of the poverty trap, apart from livelihood-sustaining measures in an era of economic liberalisation and globalisation, strengthening of public health care facilities in tribal areas needs foremost attention. More so as tribals are usually found to be residing in environmentally adverse and physically less accessible areas, with scattered human settlements, and are more vulnerable to various types of endemic, contagious and seasonal diseases due to mass poverty, ignorance and absence of proper health care in-frastructure and services. Based on the field data collected on different occasions in different tribal districts of Orissa for various research studies and also from published secondary data, this article makes an attempt to analyse the livelihood patterns and living conditions of the tribals of Orissa, and the concomitant morbidity and status of health care services in the tribal regions of the state. The article also critically examines the existing health care policy of the state and its efficacy and relevance for the downtrodden in the present context of economic reforms, and the withdrawal of the state from subsidised health care services. (Source: Journal of Health Management)
Reduction in magnetic resonance imaging t2 burden of disease in patients with relapsing-remitting multiple sclerosis: analysis of 48-week data from the evidence (evidence of interferon dose-response: european north american comparative) study
Background:
The EVIDENCE (EVidence of Interferon Dose-response: European North American Comparative Efficacy) study was an international, randomized, open-label, assessor-blinded, parallel-group study assessing the efficacy and tolerability of interferon (IFN) beta-1a, 44 mcg subcutaneously (sc) three times weekly (tiw), and IFN beta-1a, 30 mcg intramuscularly (im) once weekly (qw), in patients with relapsing-remitting multiple sclerosis (RRMS). The aim of this analysis was to assess whether reductions in T2 burden of disease (BOD) were greater for patients receiving IFN beta-1a, 44 mcg sc tiw, than for those treated with IFN beta-1a, 30 mcg im qw, and to assess the impact of neutralizing antibodies (NAbs).
Methods:
A post-hoc analysis was performed on magnetic resonance imaging (MRI) data collected prospectively from the EVIDENCE study. The analysis included all patients with evaluable T2 MRI scans at the start of dosing and at week 48, and those who received at least one drug dose (n = 553). Lesions were identified by a radiologist blinded to treatment codes and the total volume of T2 lesions (BOD) was reported in mm3.
Results:
Both median percentage decreases and absolute reduction in BOD were greater in the IFN beta-1a, 44 mcg sc tiw, treatment group. The adjusted mean treatment difference in percentage change in BOD from baseline to week 48 showed a significant treatment benefit for patients treated with IFN beta-1a, 44 mcg sc tiw, over those treated with IFN beta-1a, 30 mcg im qw (-4.6%; standard error: 2.6%; p = 0.002). The presence of NAbs reduced the effect of IFN beta-1a 44, mcg sc tiw, on BOD, but BOD changes were still similar to those seen with IFN beta-1a, 30 mcg im qw.
Conclusion:
Patients with RRMS treated with IFN beta-1a, 44 mcg sc tiw, had greater reduction in T2 BOD after 48 weeks than those treated with IFN beta-1a, 30 mcg im qw, which is consistent with other clinical and MRI outcome measures in the EVIDENCE study. In patients testing positive for NAbs (NAb+) to IFN beta-1a 44 mcg sc tiw, changes in BOD were smaller than in NAb negative (NAb-) patients, but similar to those receiving IFN beta-1a, 30 mcg im qw. (Source: BMC Neurology)

[reviews] difficult extubation in low birthweight infants
Randomised trials have demonstrated that ventilation techniques which support every spontaneous breath are the most efficacious weaning modes. Nasal continuous positive airway pressure after extubation reduces the likelihood of incidents leading to the need for reintubation in very low birthweight infants; further work is needed to determine if there are advantages of particular delivery techniques. Both methylxanthines and dexamethasone facilitate weaning and extubation; the efficacy of low-dose dexamethasone merits further investigation. Assessments of the efficacy of respiratory efforts and hence the balance of respiratory drive, muscle performance and respiratory load appear to best predict weaning and extubation success. Essential to the success of weaning and extubation are dedicated staff, whether this will be assisted by computerised decision-making tools requires testing. The above approaches are not mutually exclusive and those indicated by this review as appropriately evidence based should be considered by practitioners for current use to reduce difficult/unsuccessful extubation. (Source: Archives of Disease in Childhood – Fetal and Neonatal Edition)
Safety and efficacy of bivalirudin monotherapy in patients with diabetes mellitus and acute coronary syndromes: a report from the acuity (acute catheterization and urgent intervention triage strategy) trial
Objectives
We sought to evaluate clinical outcomes of patients with diabetes mellitus in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, overall and by treatment arm.

Background
In the ACUITY trial, 13,819 patients with moderate- or high-risk acute coronary syndromes (ACS) were randomized to heparin (unfractionated or enoxaparin) plus glycoprotein IIb/IIIa inhibition (GPI), bivalirudin plus GPI, or bivalirudin monotherapy. Compared with heparin plus GPI, bivalirudin monotherapy resulted in similar protection from ischemic events with less major bleeding. Whether these results apply to patients with diabetes is unknown.

Methods
We evaluated the impact of diabetes on 30-day net adverse clinical outcomes (composite ischemia [death, myocardial infarction, or unplanned ischemic revascularization] or major bleeding), overall and by antithrombotic strategy.

Results
Diabetes was present in 3,852 randomized patients (27.9%). Compared with nondiabetic patients, diabetic patients had higher 30-day rates of net adverse clinical outcomes (12.9% vs. 10.6%; p &lt; 0.001), composite ischemia (8.7% vs. 7.2%; p = 0.003), and major bleeding (5.7% vs. 4.2%; p &lt; 0.001). Among diabetic patients, compared with heparin plus GPI, bivalirudin plus GPI resulted in similar rates of net adverse clinical outcomes (14.0% vs. 13.8%; p = 0.89), while bivalirudin monotherapy resulted in a similar rate of composite ischemia (7.9% vs. 8.9%; p = 0.39) and less major bleeding (3.7% vs. 7.1%; p &lt; 0.001), yielding fewer net adverse clinical outcomes (10.9% vs. 13.8%; p = 0.02).

Conclusions
Diabetic patients with ACS managed invasively have higher rates of composite ischemia and major bleeding. Compared with treatment with heparin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding, resulting in a significant reduction in net adverse clinical outcomes. (Source: Journal of the American College of Cardiology)
A safety and efficacy study of a resorbable hydrogel for reduction of post-operative adhesions following myomectomy
BACKGROUND
This multicenter, randomized, single-blind study assessed the safety and efficacy of a resorbable hydrogel (&lsquo;Hydrogel&rsquo;) for the reduction of post-operative adhesion formation following myomectomy.

METHODS
Women (n = 71) who were undergoing laparoscopic (67.6%) or laparotomic myomectomy were randomized (2:1) to Hydrogel (sprayed over surgically treated areas prior to wound closure, n = 48) or to control (standard care, n = 23). Patients (38 Hydrogel, 20 control) returned 8&ndash;10 weeks later for a second look. Adhesions were graded using a modified American Fertility Society (mAFS) scoring method. The primary efficacy measure was the posterior uterus mAFS score.

RESULTS
For Hydrogel and control patients, respectively, mean &plusmn; SD mAFS scores were 0.5 &plusmn; 1.4 and 0.0 &plusmn; 0.0 at baseline, and 1.1 &plusmn; 1.9 and 2.6 &plusmn; 2.2 at the second look. Similarly, mean changes from baseline were 0.8 &plusmn; 2.0 and 2.6 &plusmn; 2.2 (P = 0.01); 95% confidence intervals for these mean changes were (0.16&ndash;1.44) and (1.64&ndash;3.56). Adverse events were reported by 9.6 and 17.4% of Hydrogel and control patients, respectively. No intra-abdominal infections or post-operative site infections were reported.

CONCLUSIONS
This 71-patient study provides the first clinical evidence of the safety and efficacy of Hydrogel for the reduction of adhesions following myomectomy.
The ClinicalTrials.gov Identifier is NCT00562471. (Source: Human Reproduction)
Quetiapine decreases alcohol consumption, craving, and psychiatric symptoms in dually diagnosed alcoholics
Patients with dual diagnosis are often excluded from clinical trials although more than half of all individuals with Bipolar Disorder have a substance abuse problem at some point in their lifetime, representing a high-risk clinical population. The purpose of this study was to investigate the safety and efficacy of quetiapine in the treatment of alcohol dependence comorbid with disorders characterized by high levels of mood and behavioral instability.Twenty-eight subjects, after a detoxification period, were orally treated with flexible doses of quetiapine for 16 weeks. At each assessment patients were evaluated through the Obsessive Compulsive Drinking Scale (OCDS), the Visual Analogue Scale (VAS) for craving, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS), the Young Mania Rating Scale (YMRS), and the Clinical Global Impression (CGI) scale.Forty-three percent of patients remained totally alcohol free, 32% patients relapsed, with an average of 15.4 drinking days in the period of the study (112 days) and 25% dropped-out. Significant reductions from baseline to exit were observed in the OCDS, VAS, BPRS, HDRS, and number of drinking days per week. Changes in alcohol craving correlated with psychiatric symptoms as to BPRS and HDRS, with the highest level of correlation evidenced for the HDRS items of insomnia.In this open-label study, quetiapine decreased alcohol consumption, craving for alcohol, and psychiatric symptoms intensity, maintaining a good level of tolerance. A strength of this study is that the use of quetiapine was not adjunctive with other pharmacological and non-pharmacological treatment. Double-blind placebo-controlled studies are required with a larger study population to confirm these data. In the meantime, for a select group of psychiatric patients, quetiapine may offer some advantages in preventing relapse. Copyright � 2008 John Wiley & Sons, Ltd. (Source: Human Psychopharmacology: Clinical and Experimental)
Efficacy of lamotrigine in the management of chemotherapy-induced peripheral neuropathy
Lamotrigine, an antiepileptic agent, has been reported as being effective in reducing symptoms of neuropathy associated with various etiologies. Based on such data, a multicenter double-blind, placebo-controlled, randomized trial was conducted to evaluate the effect of lamotrigine on pain and other neuropathic symptoms due to chemotherapy-induced peripheral neuropathy (CIPN).Patients with symptomatic CIPN with symptom scores of either 1) >3 on a 0-10 Numerical Rating Scale (NRS) or 2) >1 on the 0-3 the Eastern Cooperative Oncology Group (ECOG) neuropathy scale (ENS) were eligible (higher numbers corresponding to greater severity of symptoms in both scales). Patients were randomly assigned to receive lamotrigine (target dose of 300 mg/day) or placebo for 10 weeks. Endpoints were measured biweekly.In all, 131 patients were enrolled. Both groups were well matched at baseline. Over the 10-week period of the trial, the average pain scores (NRS) for the lamotrigine and placebo arms declined in both arms, with no statistically significant difference noted between the changes in the 2 groups (0.3 and 0.5 unit reduction from baseline, respectively; P = .56). Similarly, decreases in the ENS with therapy were not statistically different (0.4 and 0.3, respectively; P = .3). Changes in other subjective symptom scales were also not found to be statistically different between the 2 groups. Toxicities were mild and similar in each group.The results suggest that lamotrigine is not effective for relieving neuropathic symptoms in patients because of CIPN. Cancer 2008. � 2008 American Cancer Society. (Source: Cancer)
Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial
Given observational findings that physical activity reduces breast cancer risk, improves survival, and improves quality of life in breast cancer survivors, a need has been identified for randomized controlled trials that testthe efficacy of exercise on biological mechanisms associated with breast cancer survival. The primary aims of the Yale Exercise and Survivorship Study were to 1) determine the feasibility of recruiting breast cancer survivors into a randomized controlled trial of the effects of exercise on biological markers and/or mechanisms associated with survival, 2) compare the effectiveness of various recruitment strategies on accrual rates and baseline characteristics, and 3) report adherence to the exercise trial.Seventy-five postmenopausal breast cancer survivors self-referred into the trial or were recruited through the Connecticut Tumor Registry and randomly assigned to an exercise (n = 37) or usual-care (n = 38) group. The exercise group participated in 150 min/wk of supervised gym-based and home-based aerobic exercise for 6 months. The usual-care group was instructed to maintain current physical activity level.A total of 75 women (an accrual rate of 9.5%) were randomized to the trial. Rates of accrual were higher for women who self-referred into the study (19.8%) compared with women recruited via the cancer registry (7.6%); however, demographic, physiologic, and prognostic characteristics did not differ between the 2 recruitment strategies. On average, exercisers increased moderate- intensity to vigorous-intensity aerobic exercise by 129 minutes per week compared with 44 minutes per week among usual-care participants (P < .001). Women in the exercise-intervention group increased their average pedometer steps by 1621 steps per day compared with a decrease of 60 steps per day among women in the usual-care group (P < .01).Findings from this study will provide useful information for investigators who are conducting exercise trials in cancer populations, clinicians who are treating women diagnosed with breast cancer, and exercise professionals who are developing community-based exercise programs for cancer survivors. Cancer 2008. � 2008 American Cancer Society. (Source: Cancer)

have sought the intervention of Chinese have found that the once unconquerable cigarette is now a defeated foe.

Chinese and Stress Relief
The great pressure of modern-day lifestyles, stress, is a leach for many. It drains of energy and will power and leaves a person unable to cope, as the conflict of daily chores becomes unbearable stress continues to influence lives for the worse. Chinese is shown to be a highly efficient sluice gate for unwanted stress. A skilled acupuncturist has the ability to insert needles with a high degree of precision. There are meridian points around the body that will release body energies and bring about an almost instant relief from the inhibiting force of unwanted and harmful stress.

A Simple Technique to Try
Here’s a little experiment to try the next time you are faced with a level of stress that you would rather do without: its based on Chinese acupuncture.

Take the thumb and forefinger of your left, or right hand, in a pinching form. With this pinch take hold of the fleshy part that is situated between the thumb and forefinger of the other hand. Now gently massage that are with the thumb and forefinger. After a minute or two your body will begin to release nature enzymes and chemicals that will help reduce the level of stress that you are experiencing. What you’re doing is applying pressure on one of those ancient Chinese points. Have a good day – and may God bless you.

Article Source: http://www.NewArticlesOnline.com

Peter Wellington writes for www.acupunctureaid.com, a website providing a comprehensive archive of free information and guides on the ancient art of Chinese Acupuncture.

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