Conventional Treatment Schemes Research Articles

Incremental hemodialysis and vascular access complications: a 12-year experience in a hospital hemodialysis unit.

Incremental hemodialysis (HD) is considered a valid alternative for patients with residual kidney function. Evidence concerning its effect on vascular access is scarce. We present our 12-year experience of an incremental hemodialysis program with the aim of evaluating survival and complications of arteriovenous fistula in these patients compared to the thrice-weekly scheme. From January 1st, 2006 to December 31st, 2017, 220 incident patients startedhemodialysis, 132 (60%) of whom began hemodialysis with two sessions per week and 88 (40%) with three sessions per week. Demographic and clinical variables were assessed at the start of treatment. Data regarding arteriovenous fistula survival and complications were collected. Both groups had similar baseline sociodemographic and clinical characteristics. A total of 188 (85%) patients were dialyzed with an arteriovenous fistula during follow-up. Eighty-three patients had one or more fistula complications, with no differences between incremental and conventional groups (p = 0.55). Fistula survival rates showed no significant difference between the two groups, whether analyzed from the date of fistula creation (Log Rank p = 0.810) or from the date of initial fistula cannulation (Log Rank p = 0.695). We found no differences in arteriovenous fistula survival or complication rate between patients who started HD with an incremental versus a conventional treatment scheme. Randomized controlled clinical trials may be warranted to achieve a higher degree of evidence.

River Bank Filtration Process Using Groundwater Flow Modeling and Particle Tracking Approach in a Saline Coastal Aquifer

River bank filtration (RBF), as one of the sustainable natural treatment techniques, can provide risk-free drinking water supply to rural villages where piped water supply through conventional treatment schemes is very expensive. The main purpose of this paper is to report the results of a RBF production well implemented in a complex hydrogeological setting under the ephemeral Varaha river influenced by the saline coastal aquifer in the Visakhapatnam district of Andhra Pradesh (India) for the supply of drinking water to the nearby rural habitats that have no organized water supply. To understand and identify the hydraulics of the river–aquifer exchanged water, particle tracking analysis to determine the travel times of river water path lines, capture zones, the proportion of bank filtrate and river water, and groundwater into RBF production well consequent to pumping were carried out using modular finite difference groundwater flow model (MODFLOW) in conjunction with a particle-tracking model for MODFLOW (MODPATH). The river–aquifer and well field interaction were studied by developing a two-dimensional two-layer groundwater flow model with a partially penetrating well in an unconfined aquifer. The flow modeling simulation results together with MODPATH particle tracking analyses revealed that the installed RBF production well could yield about 61% river water through bank filtration and the remainder from the groundwater. The flow model was also used to optimize the pumping duration from the RBF production well without compromising the water quality of the bank filtrate water. The optimum pumping duration was estimated to be 5 h a day at the rate of 31.2 m3/h from continuous pumping during the monsoon period. The performance and quality of the bank filtrate from the well demonstrated that the RBF technique could also be a potential and viable approach for the supply of safe drinking water from an ephemeral river-induced bank filtrate influenced by the saline coastal aquifer.

THE RESPONSE OF SOME ROMANIAN AND FOREIGN APPLE CULTIVARS TO THE NATURAL INFECTIONS CAUSED BY PODOSPHERA LEUCOTRICHA, IN BISTRIȚA AREA

It is desirable that in the newly established apple orchards to be promoted as many Romanian cultivars that have genetic resistance to diseases. That is why we considered important the evaluation of some Romanian apple varieties whose expansion in culture is desired, in terms of their behaviour to the attack of the fungus Podosphera leucotricha, one of the most harmful pathogens that damage apples. The evaluation of the cultivars was performed in the period 2019 – 2021, in the experimental plots of Research Station for Fruit Growing (RSFG) Bistrita and targeted six Romanian cultivars and five foreign cultivars. Observations were made both in the untreated plots and in the plots where conventional treatment schemes were applied. The results highlight the varieties created at SCDP Bistriţa: 'Bistrițean' and 'Starkprim' which, together with 'Starkrimson', stood out due to the absence of powdery mildew symptoms in the three years of study.The cultivars known to be sensitive to powdery mildew, 'Idared' and 'Jonathan' were most affected, followed by 'Golden Delicious'. The cultivars 'Florina', 'Generos' and 'Auriu de Bistrița' showed a medium to low sensitivity and 'Aura' and 'Salva' very low sensitivity.

Valganciclovir as Add-On Therapy Modifies the Frequency of NK and NKT Cell Subpopulations in Disseminated Kaposi Sarcoma Patients.

Simple SummaryKaposi sarcoma is one disease that develops in people living with HIV with severe immunosuppression and impacts morbidity and associated mortality. This disease is currently treated with antiretroviral therapy and chemotherapy agents that can further contribute to immunosuppression in patients. Thus, searching for new therapies to induce a robust immune system activation in these patients is necessary. Herein, the frequency and phenotype of natural killer subpopulation cells in people living with HIV with Kaposi sarcoma were evaluated. After KS diagnosis, patients started antiretroviral therapy or valganciclovir plus antiretroviral therapy. Results showed that in patients treated with valganciclovir plus antiretroviral therapy, the expression of CD57 and CD27 proteins on natural killer cells was regulated, enhancing the immune response of the study cohort. This finding contributes to understanding more about the immune response of people living with HIV with Kaposi sarcoma.Human herpesvirus-8 infection (HHV-8) is the causative agent of Kaposi sarcoma (KS) and is highly prevalent among people living with HIV (KS/HIV). It has been reported that valganciclovir (VGC) reduces HHV-8 replication in KS/HIV patients. However, currently it is unclear if VGC modifies the frequency and induces changes in markers of immune regulation of immune cells necessary to eliminate HHV8-infected cells, such as Natural Killer (NK) and NK T cells (NKT). This study evaluated the effect of VGC used as antiviral HHV8 therapy in KS patients on the frequency of NK and NKT subpopulations based on the CD27 and CD57 expression, and the immunosenescence markers, PD-1 and KLRG1. Twenty KS/HIV patients were followed-up at baseline (W0), 4 (W4), and 12 weeks (W12) of the study protocol. Among them, 10 patients received a conventional treatment scheme (CT), solely antiretroviral therapy (ART), and 10 patients received a modified treatment regime (MT), including VGC plus ART. In both groups, bleomycin/vincristine was administrated according to the treating physician’s decision. The soluble levels of IL-15, PD-L1, PD-L2, and E-cadherin were quantified across the follow-up. Our results showed that the higher IL-15 levels and lower NK frequencies cells in KS/HIV patients reach almost normal values with both treatments regimes at W12. CD27+ NK and NKT cell frequencies increased since W4 on KS/HIV patients with MT. Furthermore, PD-1 expression decreased while KLRG1 increased on NK and NKT subpopulations at W12, and it is accompanied by increased PD-L1 plasma level since W4. Our study highlights the disruption of NK and NKT subpopulations in patients with KS/HIV and explores VGC treatment’s contribution to immune reconstitution during the first weeks of treatment.

Intelligent Support for Selection of Therapeutic Stabilization Schemes in Mixed Ischemic Injury

A methodology based on synthesis of hybrid fuzzy models was used to obtain a system of mathematical models for assessment of the severity of ischemic processes in the central hemodynamic system, the lower limbs, the heart, and the brain, and for classification of normal, latent, reversive, and critical states of the organs of interest. An algorithm for selection of rational prophylactic and treatment schemes was developed for different classes of states of the organs of interest. As compared with conventional treatment schemes, and using a variety of criteria for assessment of efficacy, the algorithm proposed here provided 2.4-fold faster (by 58%) achievement of positive results and a 2.5-fold (by 73%) decrease in the risk of limb amputation.

Эффективность ингибиторов фосфодиэстеразы 5-го типа в терапии симптомов нижних мочевыводящих путей у пациентов с доброкачественной гиперплазией предстательной железы и сочетанной эректильной дисфункцией

Lower urinary tract symptoms (LUTS) in combination with benign prostatic hyperplasia and erectile dysfunction are more common than commonly thought. Unfortunately, urologists often dont ask about concomitant erectile dysfunction in patients with irritative or obstructive symptoms, which leads to the progression of underline disease, a deterioration in the quality of sexual life, and, as a result, overall quality of life. The relevant studies of recent years dedicated to feasibility of using tadalafil 5 mg a day are analyzed in the article. In addition, the results of scientific work conducted on the Department of Urology and Andrology of Faculty of Fundamental Medicine of Lomonosov Moscow State University, whose aim was to study the efficiency of phosphodiesterase-5 inhibitors in patients with LUTS of varying severity in combination with other types of drugs, are presented. Tadalafil in a dose 5 mg leads to a decrease in the severity of LUTS, as confirmed by a decrease in the mean I-PSS score by 2.19 points in the presented studies. No significant changes were found in Qmax (>0,05). We also proved in our work that phosphodiesterase-5 inhibitor can supplement any combined therapy for benign prostatic hyperplasia in the case of concomitant erectile dysfunction. Tadalafil in a dose 5 mg once a day can be recommended as monotherapy for patients with moderate LUTS caused by benign prostatic hyperplasia with concurrent erectile dysfunction, as an alternative to conventional treatment schemes.

The state of immune system during the use of probiotic lactobacilli in complex treatment of papillomavirus infection

Aim. Assessment of impact of probiotic lactobacilli complex on treatment efficiency and normalization of immune status in women with human papillomavirus infection (PVI).Methods. Total of 65 patients of reproductive age with cervical pathology and PVI were examined. «Provag» was included into the standard therapy as the source of probiotic lactobacilli complex. Immunological studies were conducted before and after the treatment. The phenotypic profile of peripheral blood lymphocytes was determined by means of flow cytometry. The concentration of immunoglobulin A, G and M in serum was determined by ELISA.Results. Decreased amounts of T- and NK-cells were observed in PVI patients on day 1. Regardless of treatment method, by day 30 the number of T-lymphocytes in the blood of women with PVI increases. Percentage of NK-cells remained below the normal values on day 30 in the group of patients who received traditional scheme of PVI treatment. Patients with PVI taking additionally probiotic lactobacilli complex showed an increase of NK-cells by the end of the treatment. On day 1 decrease of relative and absolute numbers of T-helper cells was detected. Regardless of the method of treatment by day 30 the number of T-helper cells increases to the reference level. IgM and IgG levels in peripheral blood of women with PVI were increased even on day 1. By the end of the observation period their concentration in patients with conventional treatment scheme remained increased. Patients receiving the standard therapy supplemented with «Provag» demonstrated the decrease of these classes of immunoglobulins to the reference level.Conclusion. As a result of treatment normalization of NK-cells and T-helpers numbers was observed whereas the IgG and IgM levels remained increased.

Clinical efficacy of vitamin support in lung adenocarcinoma patients treated with pemetrexed second-line chemotherapy

To analyze the clinical efficacy and toxicity of vitamin support in lung adenocarcinoma patients treated with pemetrexed second-line chemotherapy. Two hundred and eighty-three patients with stage 3/4 lung adenocarcinoma treated at our hospital from August 2010 to August 2013 were included in this study. The lung adenocarcinomas in all the 283 patients were confirmed by pathology or cytology, all were EGFR-negative, and all patients received pemetrexed second line chemotherapy. The 283 patients were randomly divided into two groups: the improved treatment group (142 cases) and the conventional treatment group (141 cases). The patients of conventional treatment group received 400 µg folic acid per os daily for 7 days before the first dose of pemetrexed, and continued until 21 days after the last dose of pemetrexed. Besides, they received 1000 µg vitamin B12 injection at 7 days before the first dose of pemetrexed, and once per cycle of pemetrexed for 3 cycles after the last dose of pemetrexed. The patients of the improved treatment group took 400 µg folic acid daily per os from the day before the first dose to 21 days after the last dose of pemetrexed. They also received 500 µg vitamin B12 by injection one day before the first dose, and one day before each therapy cycle of pemetrexed therapy. The mean number of cycles of pemetrexed chemotherapy was 4 in both groups. In the 142 patients of improved treatment group, complete response (CR) was observed in two cases, partial remission (PR) in 28, stable disease (SD) in 21, and progressive disease (PD) in 91 cases, with a total effective rate of 21.1%. While in the conventional treatment group, CR was observed in one case, PR in 27 cases, SD in 23 cases, and PD in 90 cases, with a total effective rate of 19.9%. The median progression-free survival (PFS) was 3.8 months in the improved treatment group and 4.2 months in the conventional treatment group (P=0.143). The toxicity of chemotherapy was mild in both groups, with no significant difference between the two groups (P>0.05). The most common side effects of hematological system were leukopenia and neutropenia, and the most common side effects of non-blood system were nausea and vomiting. The most common grade 3-4 toxic reaction in both groups was leukopenia and neutropenia, with no significant difference between the two groups (P>0.05). Multivariate analysis showed that the age of patients was an independent factor of grade 3-4 chemotherapy toxic reaction (P<0.05), while gender, the baseline level of PS score or blood system had no significant effect on the grade 3-4 chemotherapy toxic reaction (P>0.05). Compared with the conventional treatment scheme, the improved treatment scheme has similar therapeutic effects and could be used more conveniently, while the toxic effects of chemotherapy are not increased at the same time. Our results indicate that pemetrexed-based chemotherapy does not need to delay the chemotherapy because of vitamin support treatment.

Diseño e Implementación de un Prototipo Médico para el Tratamiento y Control de la Diabetes Mellitus Tipo 1

La actualización de los esquemas convencionales de tratamiento para la diabetes mellitus tipo 1 junto con el desarrollo de preparados biosintéticos más efectivos propiciaron la aparición de la terapia intensificada con insulina, que permite balancear el total de carbohidratos ingeridos por los diabéticos con la insulina administrada exógenamente, y en consecuencia, los faculta para elegir dietas más autónomas y flexibles. No obstante, la dificultad al cuantificar carbohidratos en comestibles con formas y tamaños irregulares y la consecuente inexactitud de las dosis o bolos de insulina calculados para cubrir las ingestas alimenticias, constituyen los principales inconvenientes del tratamiento desde la perspectiva de los pacientes. Este artículo muestra el diseño y construcción de un prototipo cuantificador de carbohidratos según el peso de los alimentos, pionero en la industria nacional y diseñado a la vanguardia de las nuevas tecnologías para el cuidado de la diabetes. Se presenta también una aplicación móvil asociada al dispositivo construido que proporciona una interfaz interactiva para usuarios y permite el cálculo de bolos de insulina adecuados a las necesidades del paciente. Los resultados obtenidos y los estudios científicos citados exaltan el gran potencial del prototipo desarrollado para asistir al diabético en el control de su patología.

Complementary passive hydrotherapy WATSU (WaterShiatsu) in the rehabilitation of a severely traumatized accident survivor – A prospective case report

Introduction: The implementation of complementary and alternative therapies into conventional treatment schemes is gaining popularity. However, their use is widely depending on patients’ drive. This case-report focuses on a patient’s experience of the integration of WATSU (WaterShiatsu) in rehabilitative care. Methods: Patient: A 52 year old woman survived a severe motorcycle-accident in which she sustained several fractures on the right side of her body, including ribs, pelvis, and femur. After discharge from stationary care, she independently added WATSU to her rehabilitative regimen. Treatment approach: WATSU is a passive form of hydrotherapy in warm water that aims at relaxation, pain relief, and a sense of secureness. In the reported case, an experienced WATSU-therapist who is also trained in physiotherapy and psychosomatics delivered weekly sessions of one hour duration. Measures used: Qualitative data were collected by patient’s diary. Also the therapist’s notes including The Patient Specific Functional Scale (PSFS) were considered. Results: The patient associated WATSU with trunk mobilization (followed by ameliorated breath), reconciliation with her body, and emotional discharge. She ascribed WATSU lasting effects on her body-image. The therapist employed WATSU for careful mobilization and to equalize awareness throughout the body. The PSFS displayed continuous improvement in all categories except usage of public transportation. Due to complications (elevated inflammation markers) only 6 of 8 scheduled sessions were administered. Conclusions: WATSU was experienced helpful in approaching conditions that are difficult to address by conventional physiotherapy. In early rehabilitation, additional medical/physiotherapeutic skills of contributing complementary therapists are advocated.

Comprehensive analysis of therapeutic effect nucleo cmp forte for injuries inferior alveolar nerve

The aim of our study became a comparative description of main indicators of pain syndrome in patients with mandibular fractures, accompanied by damage of inferior alveolar nerve using conventional treatment scheme, supplemented by application of Nucleo CMP forte. Materials and methods. In order to achieve the indicated objective, we have performed a surgical interference and further post-surgical treatment of 60 patients with angular mandibular fractures, accompanied by clinical picture of damaging inferior alveolar nerve alveolar nerve. Results. The use of Nucleo CMP forte completely eliminates unpleasant subjective symptoms such as burning sensation, allodynia (distorted pain), sensation of tingling, cramp (twitching). There was a slight positive dynamics in the complaints of the patients on disesthesive symptoms in the region of the mandible in the comparison group. In the main group disesthesive symptoms at the end of the observation period were missing, and objective symptoms of inferior alveolar nerve dysfunction had a significant regression. In the main group after treatment a significant positive trend for improving the conduction of the inferior alveolar nerve revealed. Conclusions. Thus, after analyzing the dynamics of complaints and objective data for mandibular fractures in the area of the angle, which is accompanied by damage of the inferior alveolar nerve, it was found that using of Nucleo CMP forte accelerates regression of pain syndrome in the course of treatment. This drug considerably reduces the intensity of manifestations of all kinds of neuropathy connected with inferior alveolar nerve damage

Antibody, T-cell and Dendritic Cell Immunotherapy for Malignant Brain Tumors

Modest improvement in brain tumor patient survival has been achieved through advances in surgical, adjuvant radiation and chemotherapeutic strategies. However, these traditional approaches have been unsuccessful in permanently controlling these aggressive tumors, with recurrence being quite common. Hence, there is a need for novel therapeutic approaches that specifically target the molecularly diverse brain tumor cell population. The ability of the immune system to recognize altered tumor cells while avoiding surrounding normal cells offers an enormous advantage over the nonspecific nature of the conventional treatment schemes. Therefore, immunotherapy represents a promising approach that may supplement the standard therapies in eliminating the residual brain tumor cells. This review summarizes different immunotherapeutic approaches currently being tested for malignant brain tumor treatment.

Real-time monitoring of nanoparticle retention in porous media

Nanoparticles are not specifically targeted in conventional treatment schemes; consequently, typical wastewater treatment systems are ineffective for nanoparticles removal. With rapidly increasing concern over their health effects, improved understanding of nanoparticle transport and retention in porous media filters is critical because of its application in new wastewater treatment methods and for assessment of the fate of the discharged nanoparticles in soil. In this study, a unique and robust integrated method is developed and validated. Experimentally, this approach uses an on-line, real-time, and in situ method for measuring nanoparticle retention dynamics, eliminating the laborious and less accurate sampling and off-line analysis. The data analysis part is a process simulator which provides both kinetic properties of the retention process as well as the overall capacity and loading. This technique is validated by application to the transport and retention of TiO2 nanoparticles in two vastly different porous filtration media—activated carbon and sand. TiO2 retained concentrations ranged from 0.24 to 0.37 mg g−1 for activated carbon and 0.01–0.014 mg g−1 for sand. The integrated method presented here is useful for both comparison of the filtration effectiveness of various porous materials as well as for process optimization and scale-up for industrial applications.

Drug resistance of Mycobacterium tuberculosis strains in southern Brazil

The aim of this work was to evaluate the prevalence of Mycobacterium tuberculosis (MT) strains with mutations that could result in resistance to the main drugs used in treatment in a region with one of the highest numbers of tuberculosis (TB) cases in southern Brazil. Deoxyribonucleic acid (DNA) from 120 sputum samples from different patients suspicious of pulmonary tuberculosis who attended the Municipal Public Laboratory for Mycobacterium sp. diagnosis was directly amplified and analyzed by PCR-SSCP. The DNA was amplified in known hotspot mutation regions of the genes rpoB, ahpC, embB, katG, inhA, and pncA. The percentage of samples positive by culture was 9.2% (11/120); 5% (6/120) were positive by bacilloscopy and MT-PCR, and DNA fragments of the aforementioned resistance genes could be amplified from seven (7) of the eleven (11) samples with positive results, either by culture or PCR/bacilloscopy. All presented a SSCP pattern similar to a native, nonresistant genotype, with the ATCC strain 25177 as control, except for one sample (0.01%), which presented a SSCP profile demonstrating mutation at the embB gene. These results are consistent with the empirical observations by physicians treating TB patients in our region of a low occurrence of cases that are refractory to conventional treatment schemes, in contrast to other parts of the country. Continued surveillance, especially molecular, is essential to detect and monitor the outbreak of MT-resistant strains.

UV/H2O2 degradation of endocrine-disrupting chemicals in water evaluated via toxicity assays

Due to rising concern regarding the presence of endocrine-disrupting chemicals (EDCs) in surface water and groundwater throughout the United States, Asia and Europe, treatment of these chemicals in drinking water and wastewater to protect human health and the environment is an area of great interest. Many conventional treatment schemes are relatively ineffective in removing EDCs from water and wastewater. This is concerning because these chemicals are biologically active at very low concentrations and effects of mixtures are relatively unknown. 17-alpha-oestradiol (E2) and 17-beta-ethinyl-oestradiol (EE2), suspected EDCs, were degraded significantly by the UV/H2O2 AOP. The UV/H2O2 processes using either low or medium pressure lamps were degraded EDCs by between 80 and 99.3% at a 15 ppm H2O2 concentration and a UV dose of 1,000 mJ/cm2. Significantly greater removal was noted when the removal was based on total oestrogenic activity using a yeast oestrogen screen (YES) assay. These data indicated that a dose of less than 200 mJ/cm2 completely removed oestrogenic activity in lab water. Values for natural waters were slightly higher. A steady state model was developed to determine EDC destruction efficiency in waters of differing quality. The model effectively predicted destruction in water, where concentrations of all scavenging species were known. Based on these results it was concluded than complete destruction of oestrogenic activity was possible under practical advanced oxidation conditions for a variety of water qualities.

Investigation of fill and batch periods of sequencing batch biological reactors

Early use of sequencing batch (fill and draw) biological reactors was abandoned in favor of conventional continuous flow constant volume treatment systems because of operational difficulties. Recent advances in process control and the need to provide more reliable and consistent treatment have called for the re-evaluation of present biological treatment practices. Fill and draw reactors provide for equalization of flow and concentration, treatment of organics and quiescent sedimentation in the same system. This system also benefits from the theoretical advantages of the volume reductions expected from a plug flow system. Laboratory studies were conducted on fill and draw reactors. A mathematical model was developed to describe, as a function of time, the waste and organism concentration and the oxygen uptake rate. Close agreement between the measured and predicted values was obtained. These results plus the obvious potential benefits of batch treatment suggest that sequencing batch systems may serve as a process alternative to conventional treatment schemes.