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Obstetrics and Gynecology Clinics of... Sep 2000Medical treatment of ectopic pregnancy with methotrexate has been shown to be effective and safe in appropriate patients. When considering medical management, the... (Review)
Review
Medical treatment of ectopic pregnancy with methotrexate has been shown to be effective and safe in appropriate patients. When considering medical management, the definitive diagnosis of an ectopic pregnancy and the assurance that the patient is a candidate are of paramount concern. An understanding of the mechanism of action and pharmacokinetics of methotrexate allows the clinician to better inform patients, recognize and treat side effects, and be cognizant when treatment is unsuccessful. Two common protocols, the "multi-dose" and the "single-dose" protocols, have excellent success rates; however, neither one of these is completely effective. The "multi-dose" protocol appears to have a higher success rate than the "single-dose" protocol.
Topics: Abortifacient Agents, Nonsteroidal; Algorithms; Female; Humans; Methotrexate; Pregnancy; Pregnancy, Ectopic; Risk Factors; Ultrasonography, Prenatal; United States
PubMed: 10958010
DOI: 10.1016/s0889-8545(05)70162-5 -
Dental Materials : Official Publication... Mar 2024To assess visually and quantitatively the contributions of the adhesive layer photopolymerization and the subsequent resin composite increment to spatio-temporal maps of...
OBJECTIVES
To assess visually and quantitatively the contributions of the adhesive layer photopolymerization and the subsequent resin composite increment to spatio-temporal maps of temperature at five different cavity locations, subjected to two irradiance curing protocols: standard and ultra-high.
METHODS
Caries-free molars were used to obtain 40, 2 mm thick dentin slices, randomly assigned to groups (n = 5). These slices were incorporated within 3D-printed model cavites, 4 mm deep, restored with Adhese® Universal bonding agent and 2 mm thick Tetric® Powerfill resin composite, and photocured sequentially, as follows: G1: control-empty cavity; G2: adhesive layer; G3 composite layer with no adhesive; and G4 composite layer with adhesive. The main four groups were subdivided based on two curing protocols, exposed either to standard 10 s (1.2 W/cm) or Ultra high 3 s (3 W/cm) irradiance modes using a Bluephase PowerCure LCU. Temperature maps were obtained, via a thermal imaging camera, and numerically analyzed at 5 locations. The data were analyzed using two-way ANOVA followed by multiple one-way ANOVA, independent t-tests and Tukey post-hoc tests (α = 0.05). T, ΔT, T (integrated area under the curve) and time-to-reach-maximum-temperature were evaluated.
RESULTS
Two-way ANOVA showed that there was no significant interaction between light-curing time and location on the measured parameters (p > 0.05), except for the time-to-reach-maximum-temperature (p < 0.05). Curing the adhesive layer alone with the 10 s protocol resulted in a significantly increased pulpal roof temperature compared to 3 s cure (p < 0.05). Independent T-tests between G3 and G4, between 3 s and 10 s, confirmed that the adhesive agent caused no significant increases (p > 0.05) on the measured parameters. The ultra-high light-curing protocol significantly increased ΔT in composite compared to 10 s curing (p < 0.05).
SIGNIFICANCE
When the adhesive layer was photocured alone in a cavity, with a 2 mm thick dentin floor, the exothermal release of energy resulted in higher temperatures with a 10 s curing protocol, compared to a 3 s high irradiance. But when subsequently photocuring a 2 mm layer of composite, the resultant temperatures generated at pulpal roof location from the two curing protocols were similar and therefore there was no increased hazard to the dental pulp from the immediately prior adhesive photopolymerization, cured via the ultra-high irradiation protocol.
Topics: Humans; Temperature; Thermography; Dental Cements; Composite Resins; Dental Caries; Materials Testing; Resin Cements; Dentin
PubMed: 38129192
DOI: 10.1016/j.dental.2023.12.006 -
Journal of the National Cancer Institute May 2020In the modern era of targeted and immune-based therapies, investigator and patient expectations of availability and efficacy in phase I trials have increased. We...
In the modern era of targeted and immune-based therapies, investigator and patient expectations of availability and efficacy in phase I trials have increased. We assessed availability of, and benefit from, early drug development trials, specifically in patients with gastrointestinal cancers. We reviewed computerized referral records of the Early Drug Development Service at our institution to identify patients internally referred from our Gastrointestinal Oncology Service in calendar year 2018. End points were treatment on a trial, 3- and 6-month progression-free survival (PFS), and any tumor shrinkage. Of 394 gastrointestinal cancer patients referred in 2018, 54 enrolled on a trial and 53 (13.5%) were treated (1 withdrew before treatment): 34 on immune-based and 19 on targeted (3 to phase II basket) studies. None of the 52 patients who had exhausted standard therapy achieved 6-month PFS, two (3.8%) met 3-month PFS with tumor growth below Response Evaluation Criteria in Solid Tumors progression at 3 months, and both came off study for progression at 4 months. One patient who was to receive an irinotecan-based regimen as standard therapy instead received irinotecan plus an investigational targeted agent and remained stable for 8 months. No patients achieved any degree of tumor shrinkage. The most common reasons for nonaccrual were lack of available protocol treatment openings and failure to meet eligibility criteria for specific trials. Thus, availability and benefit from investigational treatment in this treatment-refractory gastrointestinal cancer patient population was extremely modest. Expectations regarding both availability and efficacy of phase I investigational therapy in gastrointestinal cancer patients likely exceed what our experience suggests.
Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Clinical Trials, Phase I as Topic; Drugs, Investigational; Gastrointestinal Neoplasms; Health Services Accessibility; Humans
PubMed: 31834379
DOI: 10.1093/jnci/djz228 -
Saudi Journal of Biological Sciences Oct 2020Nanotechnology is evolving as a significant discipline of research with various applications. It includes the materials and their applications having one dimension in... (Review)
Review
Nanotechnology is evolving as a significant discipline of research with various applications. It includes the materials and their applications having one dimension in the range of 1-100 nm. Many chemical and physical protocol have been utilized for the nanoparticles (NPs) fabrication. These protocols are costly, hazardous and consumes high energy. Thus, researchers are inclined towards biological synthesis of NPs using plant and or herbal extract as these methods are simple, sustainable, ecofriendly and cost-effective. Flower is an important part of plants, and contained several phytochemicals such as flavonoids, terpenoids, coumarins, sterol and xanthones which acts as an important precursor for NPs synthesis. These compounds acted as reducing as well as stablishing agent during fabrication processes. They have been thoroughly characterized by various techniques. The fabricated NPs have shown potential antimicrobial activity against bacterial and fungal infections. They have been also used as potential therapeutic agent for human breast cancer, gastric adenocarcinoma cell, colorectal adenocarcinoma cell and pancreas ductal adenocarcinoma cells. Overall, the aim of this review article to facilitates the recent understanding of flower-mediated NPs fabrication (a sustainable and ecofriendly resource), their application in different disciplines and challenges.
PubMed: 32994711
DOI: 10.1016/j.sjbs.2020.05.012 -
Sensors (Basel, Switzerland) Jun 2022Recently, the Internet of Things (IoT) has emerged as an important way to connect diverse physical devices to the internet. The IoT paves the way for a slew of new...
Recently, the Internet of Things (IoT) has emerged as an important way to connect diverse physical devices to the internet. The IoT paves the way for a slew of new cutting-edge applications. Despite the prospective benefits and many security solutions offered in the literature, the security of IoT networks remains a critical concern, considering the massive amount of data generated and transmitted. The resource-constrained, mobile, and heterogeneous nature of the IoT makes it increasingly challenging to preserve security in routing protocols, such as the routing protocol for low-power and lossy networks (RPL). RPL does not offer good protection against routing attacks, such as rank, Sybil, and sinkhole attacks. Therefore, to augment the security of RPL, this article proposes the energy-efficient multi-mobile agent-based trust framework for RPL (MMTM-RPL). The goal of MMTM-RPL is to mitigate internal attacks in IoT-based wireless sensor networks using fog layer capabilities. MMTM-RPL mitigates rank, Sybil, and sinkhole attacks while minimizing energy and message overheads by 25-30% due to the use of mobile agents and dynamic itineraries. MMTM-RPL enhances the security of RPL and improves network lifetime (by 25-30% or more) and the detection rate (by 10% or more) compared to state-of-the-art approaches, namely, DCTM-RPL, RBAM-IoT, RPL-MRC, and DSH-RPL.
Topics: Internet of Things; Prospective Studies; Trust
PubMed: 35746321
DOI: 10.3390/s22124539 -
Toxicology Reports 2022Kambo is the name of a natural substance derived from the glandular secretions of the amphibian , a species native to regions in South America. The communities living in... (Review)
Review
Kambo is the name of a natural substance derived from the glandular secretions of the amphibian , a species native to regions in South America. The communities living in these areas administer the substance generally transdermally during rituals for religious-purifying purposes, producing small skin burns. The scientific literature has reported some cases of intoxication following the use of Kambo but this aspect is still poorly understood. In fact, no shared therapy protocols exist for these events nor any real legislation on Kambo. The purpose of this work was to examine all cases of acute intoxication resulting from the administration of Kambo and published over the last 10 years, illustrating clinical signs, laboratory findings, instrumental tests, and therapy. The several cases identified in our review confirm that acute Kambo intoxication can occur, with serious and life-threatening effects. We developed a protocol aimed at the early diagnosis of cases of suspected acute intoxication by creating a treatment algorithm. The study aims to investigate the pathophysiology of these events in humans, proposing a protocol for the diagnosis and treatment of these cases that can be used by healthcare professionals.
PubMed: 35515815
DOI: 10.1016/j.toxrep.2022.04.005 -
Brazilian Journal of Medical and... Nov 2017Biological biomaterials for tissue engineering purposes can be produced through tissue and/or organ decellularization. The remaining extracellular matrix (ECM) must be...
Biological biomaterials for tissue engineering purposes can be produced through tissue and/or organ decellularization. The remaining extracellular matrix (ECM) must be acellular and preserve its proteins and physical features. Placentas are organs of great interest because they are discarded after birth and present large amounts of ECM. Protocols for decellularization are tissue-specific and have not been established for canine placentas yet. This study aimed at analyzing a favorable method for decellularization of maternal and fetal portions of canine placentas. Canine placentas were subjected to ten preliminary tests to analyze the efficacy of parameters such as the type of detergents, freezing temperatures and perfusion. Two protocols were chosen for further analyses using histology, scanning electron microscopy, immunofluorescence and DNA quantification. Sodium dodecyl sulfate (SDS) was the most effective detergent for cell removal. Freezing placentas before decellularization required longer periods of incubation in different detergents. Both perfusion and immersion methods were capable of removing cells. Placentas decellularized using Protocol I (1% SDS, 5 mM EDTA, 50 mM TRIS, and 0.5% antibiotic) preserved the ECM structure better, but Protocol I was less efficient to remove cells and DNA content from the ECM than Protocol II (1% SDS, 5 mM EDTA, 0.05% trypsin, and 0.5% antibiotic).
Topics: Animals; Biocompatible Materials; Cold Temperature; Collagen; Dogs; Edetic Acid; Extracellular Matrix; Female; Fetus; Fibronectins; Fluorescent Antibody Technique; Immersion; Laminin; Microscopy, Electron, Scanning; Placenta; Pregnancy; Reproducibility of Results; Sodium Dodecyl Sulfate; Surface-Active Agents; Tissue Engineering
PubMed: 29185592
DOI: 10.1590/1414-431X20176382 -
British Journal of Cancer Oct 2003Rituximab is a chimeric human/mouse monoclonal antibody that is approved for the treatment of relapsed and refractory non-Hodgkin's lymphoma (NHL) and in combination... (Review)
Review
Rituximab is a chimeric human/mouse monoclonal antibody that is approved for the treatment of relapsed and refractory non-Hodgkin's lymphoma (NHL) and in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy as first-line therapy for diffuse large B-cell NHL, where it has shown the first survival advantage over CHOP alone in more than 20 years. Strategies to help define the optimal therapeutic usage of rituximab are being assessed, including first-line and maintenance or extended therapy, and the combination of rituximab with chemotherapy in indolent NHL. Emerging data suggest that earlier use may yield higher response rates, extended therapy can prolong remission, and the addition of rituximab to chemotherapy can increase clinical and molecular remission rates when compared with those achieved using chemotherapy alone. Studies in the peritransplant setting suggest a role for rituximab in vivo purging prior to transplant and/or maintenance rituximab as a means of clearing minimal residual disease. Rituximab has also shown activity in other B-cell disorders such as chronic lymphocytic leukaemia. The full potential of this immunotherapeutic agent remains to be defined in ongoing and future clinical trials.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Cyclophosphamide; Doxorubicin; Drug Administration Schedule; Hematologic Neoplasms; Humans; Peripheral Blood Stem Cell Transplantation; Prednisone; Rituximab; Vincristine
PubMed: 14562003
DOI: 10.1038/sj.bjc.6601187 -
Current Opinion in Ophthalmology May 2016Diabetic retinopathy and diabetic macular edema (DME) are common eye diseases leading to vision loss. The Diabetic Retinopathy Clinical Research Network (DRCRnet), a... (Review)
Review
PURPOSE OF REVIEW
Diabetic retinopathy and diabetic macular edema (DME) are common eye diseases leading to vision loss. The Diabetic Retinopathy Clinical Research Network (DRCRnet), a collaboration of private and academic practices supported by the National Eye Institute and the National Institute of Diabetes, Digestive and Kidney Diseases has studied diabetic eye disease for 13 years. This review will discuss the network's findings over the last year, when some of its most important contributions were reported.
RECENT FINDINGS
The DRCRnet reported intravitreal bevacizumab, ranibizumab and aflibercept all improve visual acuity in DME. With baseline vision of 20/30 to 20/40, all agents had similar efficacy. With baseline vision of 20/50 or worse, aflibercept resulted in superior visual improvement. Protocol S, which compared panretinal photocoagulation with intravitreal injections of ranibizumab for proliferative diabetic retinopathy (PDR), found vision outcomes and surgery rates were not inferior in the injection group. Secondary outcomes indicate improved functional results with ranibizumab supporting injections as a possible alternative treatment for PDR.
SUMMARY
The DRCRnet has helped clarify the role of various treatments for both DME and PDR, and will continue to evaluate treatments for these vision-threatening conditions.
Topics: Diabetic Retinopathy; Hemorrhage; Humans; Laser Coagulation; Vision Disorders; Visual Acuity
PubMed: 26913740
DOI: 10.1097/ICU.0000000000000262 -
Journal of Stroke and Cerebrovascular... Jan 2016Protocol deviations before and after tissue plasminogen activator (tPA) treatment for ischemic stroke are common. It is unclear if patient or hospital factors predict...
BACKGROUND
Protocol deviations before and after tissue plasminogen activator (tPA) treatment for ischemic stroke are common. It is unclear if patient or hospital factors predict protocol deviations. We examined predictors of protocol deviations and the effects of protocol violations on symptomatic intracerebral hemorrhage (sICH).
METHODS
We used data from the Increasing Stroke Treatment through Interventional Behavior Change Tactics trial, a cluster-randomized, controlled trial evaluating the efficacy of a barrier assessment and educational intervention to increase appropriate tPA use in 24 Michigan community hospitals, to review tPA treatments between 2007 and 2010. Protocol violations were defined as deviations from the standard tPA protocol, both before and after treatment. Multilevel logistic regression models were fitted to determine if patient and hospital variables were associated with pretreatment or post-treatment protocol deviations.
RESULTS
During the study, 557 patients (mean age 70, 52% male, median National Institutes of Health Stroke Scale score 12) were treated with tPA. Protocol deviations occurred in 233 (42%) patients: 16% had pretreatment deviations, 35% had post-treatment deviations, and 9% had both. The most common protocol deviations included elevated post-treatment blood pressure, antithrombotic agent use within 24 hours of treatment, and elevated pretreatment blood pressure. Protocol deviations were not associated with sICH, stroke severity, or hospital factors. Older age was associated with pretreatment protocol deviations (adjusted odds ratio [OR], .52; 95% confidence interval [CI], .30-.92). Pretreatment deviations were associated with post-treatment deviations (adjusted OR, 3.20; 95% CI, 1.91-5.35).
CONCLUSIONS
Protocol deviations were not associated with sICH. Aside from age, patient and hospital factors were not associated with protocol deviations.
Topics: Age Factors; Brain Ischemia; Cerebral Hemorrhage; Clinical Protocols; Emergency Service, Hospital; Fibrinolytic Agents; Guideline Adherence; Health Personnel; Hospitals, Community; Humans; Hypertension; Infusions, Intravenous; Logistic Models; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Recombinant Proteins; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome
PubMed: 26419527
DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.036