Effective Dose For Treatment Research Articles

Assessing the complete blood count in Graves’ ophthalmopathy patients treated with RAI-131 in Iraq

Introduction and Aim: Graves ophthalmopathy is one of the pandemic public health disorders in Iraq. The current investigation attempts to determine the variation in the complete total blood cells on the recovery of individuals with Graves' ophthalmopathy following low and high-dose Radioactive Iodine 131 (RI-131) exposures. Materials and Methods: The complete blood CBC level in people with Graves' illness and healthy, normal controls were quantitatively identified using the CBC counter. Thyroid stimulating hormone was utilized to compare the recovery of ophthalmopathy patients in comparison to a control group. Results: In comparison to healthy controls, patients with Graves' ophthalmopathy disease who received 10 mci of RAI-131 had elevated lymphocyte counts (P<0.01). After one year of therapy with antithyroid drugs, lymphocyte counts rose significantly (P<0.01). In contrast, patients treated with 10 mci of RAI-131 experienced a dramatic reduction in monocytes (P< 0.01) over the course of four months. Lymphocytes, monocytes, and platelets were significantly lower in patients with ophthalmopathy after one month of therapy with 20 mci of RAI-131 compared to controls. No significant difference in red blood cells and hemoglobin levels before and after treatment with low and high doses of RAI-131 was observed. Conclusion: Assessment of lymphocytes, monocytes, granulocytes, and platelets levels in Graves' ophthalmopathy disease patients (GD ophthalmopathy) could be used as an effective diagnostic marker for determining the most effective dose for Graves' ophthalmopathy disease treatment.

Dose Reduction to Motor Structures in Adjuvant Fractionated Stereotactic Radiotherapy of Brain Metastases: nTMS-Derived DTI-Based Motor Fiber Tracking in Treatment Planning.

Background: Resection of brain metastases (BM) close to motor structures is challenging for treatment. Navigated transcranial magnetic stimulation (nTMS) motor mapping, combined with diffusion tensor imaging (DTI)-based fiber tracking (DTI-FTmot.TMS), is a valuable tool in neurosurgery to preserve motor function. This study aimed to assess the practicability of DTI-FTmot.TMS for local adjuvant radiotherapy (RT) planning of BM. Methods: Presurgically generated DTI-FTmot.TMS-based corticospinal tract (CST) reconstructions (FTmot.TMS) of 24 patients with 25 BM resected during later surgery were incorporated into the RT planning system. Completed fractionated stereotactic intensity-modulated RT (IMRT) plans were retrospectively analyzed and adapted to preserve FTmot.TMS. Results: In regular plans, mean dose (Dmean) of complete FTmot.TMS was 5.2 ± 2.4 Gy. Regarding planning risk volume (PRV-FTTMS) portions outside of the planning target volume (PTV) within the 17.5 Gy (50%) isodose line, the DTI-FTmot.TMS Dmean was significantly reduced by 33.0% (range, 5.9−57.6%) from 23.4 ± 3.3 Gy to 15.9 ± 4.7 Gy (p < 0.001). There was no significant decline in the effective treatment dose, with PTV Dmean 35.6 ± 0.9 Gy vs. 36.0 ± 1.2 Gy (p = 0.063) after adaption. Conclusions: The DTI-FTmot.TMS-based CST reconstructions could be implemented in adjuvant IMRT planning of BM. A significant dose reduction regarding motor structures within critical dose levels seems possible.

Effect of Sodium Hydroxide Treatment on Chemical Composition and Feed Value of Common Reed (Phragmites australis) Straw

This research was undertaken with the aim of determining the effect of sodium hydroxide (NaOH) treatment on the chemical composition, in vitro gas production, neutral detergent fiber digestibility (NDFD) and true dry matter digestibility (TDMD), dry matter intake (DMI), and relative feed value (RFV) of common reed (Phragmites australis) straw. Reed straw was treated with 0% (control), 1%, 2%, and 3% NaOH and stored in 1.5-L glass jars in triplicate for 21 days. NaOH treatment had a significant effect on the chemical composition, in vitro gas production, NDFD and TDMD, DMI, and RFV of the reed straw. While it decreased the cell wall content of the reed straw, it significantly increased the NDFD, TDMD, DMI, and RFV. The neutral detergent fiber content of the reed straw decreased with NaOH treatment in a dose-dependent manner and ranged from 56.03% to 65.05%, whereas the NDFD increased and ranged from 53.10% to 59.99%. Metabolizable energy, organic matter digestibility, and TDMD values were improved, ranging from 9.15 to 10.19 MJ/kg DM, 58.46% to 65.05%, and 55.29% to 62.33%, respectively. The estimated RFV and DMI also improved, ranging from 84.70% to 95.58% and from 1.87% to 2.14% of body weight, respectively. The most effective treatment dose of NaOH was 3%. Therefore, it can be suggested that NaOH treatment has the potential to improve the nutritive value of reed straw. However, before large applications, further in vivo investigations are required to determine the effects of NaOH treatment on the feed intake and production of ruminant animals.

RADT-06. SPARING OF MOTOR STRUCTURES IN ADJUVANT RADIATION THERAPY AFTER RESECTION OF BRAIN METASTASES: APPLICATION OF NTMS-DERIVED DTI-BASED MOTOR FIBER TRACKING IN ADJUVANT STEREOTACTIC RT TREATMENT PLANNING

Abstract BACKGROUND Resection of brain metastases (BM) close to the motor cortex and the corticospinal tract (CST) bears a significant risk for treatment-related morbidity. Navigated transcranial mapping (nTMS) combined with diffusion-tensor-imaging (DTI) based fiber tracking (DTI-FTTMS) is a valuable tool to guide the neurosurgeon along the CST to preserve motor function. This study aims to proof the practicability of DTI-FTTMS in local adjuvant stereotactic RT planning in the management of BM. Method: Pre-surgical generated DTI-FTTMS-based CST reconstructions of 24 patients with 25 resected BM were incorporated into the RT planning system and elastic fused with planning imaging. The CST was delineated as the planning risk volume (PRV-FTTMS). Fractionated stereotactic intensity-modulated RT (IMRT) plans (7 x 5 Gy) were retrospectively calculated and then optimized to preserve PRV-FTTMS. Areas covered by the planning target volume (PTV) were not spared (overlap). RESULTS In regular plans mean dose (Dmean) of complete PRV-FTTMS was 5.4 ± 2.5 Gy. Regarding PRV-FTTMS portions within the 8.75 Gy (25% of prescription dose) isodose level Dmean was 18.2 ± 4.3 Gy and after plan optimization 13.1 ± 3.8Gy (-28.0%, p &amp;lt; 0.001). Within the 17.5 Gy (50%) isodose line PRV-FTTMS Dmean was reduced by 31.7% from 24.3 ± 3 Gy to 16.6 ± 4.8 Gy (p&amp;lt; 0.001). There was no decline of the effective treatment dose, PTV Dmean in regular plans was 36.9 ± 0.7 Gy vs. 37.7 ± 1.4Gy (p=0.013) after adaption. PTV coverage (V35Gy(%)*100) did not change with plan optimization: 0.99 vs. 0.99 (p=0.43). Dose constraints of organs at risk were all met both in regular and optimized plans. CONCLUSION DTI-FTTMS based motor tracts could be implemented in the adjuvant stereotactic RT planning of cavities after resection of BM. A significant dose reduction of motor structures within critical dose levels seems possible without reducing PTV treatment dose. However, the functional benefit needs to be investigated prospectively within clinical trials.

Prevention of Shivering Post Subarachnoid Block: Comparison between Different Doses of Intravenous Magnesium Sulphate.

Background and Objectives: Shivering is a common complication of subarachnoid block (SAB). Magnesium sulphate has been proven to be effective in preventing shivering. The aim of this study was to compare the effectiveness and adverse effects in hemodynamic parameters between 50 mg/kg and 30 mg/kg of intravenous magnesium sulphate for prevention of shivering post-subarachnoid block. Materials and Methods: Eighty-six patients scheduled for surgery under SAB, aged between 18 to 65 years old with American Society of Anesthesiologists physical status I and II were randomised into two groups. Group A received a bolus of 50 mg/kg, while Group B received 30 mg/kg of intravenous magnesium sulphate, given over a 20 min duration following SAB. Shivering grade was recorded intraoperatively according to the Crossley and Mahajan shivering scale. Mean arterial pressure (MAP), heart rate, tympanic temperature, oxygen saturation and the use of vasopressors were recorded. Results: Forty-five percent of patients in Group A and 20% of patients in Group B did not exhibit shivering (p-value < 0.01). High-grade shivering was observed in 12.5% in Group A and 40% in Group B, respectively (p-value 0.02). The MAP trend was lower in Group B (p-value < 0.01), but the incidence of hypotension was not significant in both groups. The use of vasopressors was also similar between groups. Group B showed a lower oxygen saturation trend (p-value 0.04). The trends of heart rate and tympanic temperature were not significant in both groups. No patients had episodes of bradycardia or oxygen desaturation. Conclusions: In this study, intravenous magnesium sulphate 50 mg/kg is the lowest effective dose for prevention and treatment of high-grade shivering post-SAB without significant hemodynamic adverse events.

SCALE-1: Safety and efficacy of short course neoadjuvant chemo-radiotherapy plus toripalimab for locally advanced resectable squamous cell carcinoma of esophagus.

4063 Background: Adding PD-1 inhibitors to neoadjuvant chemoradiotherapy have shown promising results in treatment of locally advanced esophageal squamous cell carcinoma (ESCC). However, there is a need to explore more effective and safe treatment doses and schedules. The aim of this single arm phase Ib trial is to determine the safety and efficacy of short course neoadjuvant chemo-radiotherapy plus toripalimab following by esophagectomy in patients with locally advanced resectable ESCC. Methods: Patients (pts) with histopathologically confirmed thoracic ESCC, diagnosed as clinical stage of cT3-4aN0M0/cT1-4aN+M0 per AJCC 8th and ECOG PS of 0-1 were eligible. Toripalimab (240mg) was given with paclitaxel (135 mg/m2) and carboplatin (AUC=5) on D1 every 3 weeks for two cycles. Short course neoadjuvant radiotherapy (3000 cGy in 12 fractions on 5 days per week) was administered from D3 to D18. Esophagectomy was scheduled 4 to 6 weeks after the completion of neoadjuvant therapy. Target total enrollment was 20 pts. The primary endpoint was treatment safety. Pre- and post-treatment specimens were collected for PD-L1 expression assay and gene expression profiles (GEPs) analysis using the nCounter platform. Results: From Jan 29, 2021 to Nov 3, 2021, 26 patients were screened and 23 met the inclusion criteria. The majority of them were diagnosed with clinical stage of cT3-T4 (95.6%), cN1-2 (62.5%), and cTNM III-IVA (78.2%). All 23 pts finished neoadjuvant radiotherapy, while two of them didn’t receive or received reduced dose of the second cycle chemotherapy or toripalimab due to toxicity. Notable grade 3 or higher AEs included leukopenia (n=21), neutropenia (n=21), anorexia (n=19) and nausea (n=18). No treatment related oesophagitis, pneumonia and gastrointestinal hemorrhage above Grade 3 were observed. 20 pts underwent surgery after a median of 7 weeks post neoadjuvant therapy. Reasons for not undergoing surgery were patients’ choice (n=2) and tuberculosis reactivation (n=1). 3 pts with Grade III surgical complications were observed during the perioperative period. 11/20 (55%) complete pathological responses (ypT0N0) were observed, 16/20 (80%) pts were major pathologic response (MPR) and the remaining 4 pts achieved partial response. Pre-treatment GEP analysis revealed significantly higher expression levels of CXCL10, CXCL11, OAS2, and lower level of CD209 and KLRB1 in pCR (n=6) than in Non-pCR group (n=4). Moreover, pCR group showed a trend of upregulated signatures of tumor infiltrating leukocytes, cytolytic activity, cytotoxic T cell, T cell markers and Teff score (P= 0.062) after treatment. Conclusions: Combining short course nCRT with toripalimab is feasible and effective in patients with locally advanced resectable ESCC, and might be a promising approach for neoadjuvant treatment. Clinical trial information: ChCTR2100045104.

Evaluation of Anti-Urolithiatic Activity of Ethanolic Extract of Delonix Regia Leaves in Experimental Animal

The aim of the present study was to investigate the anti-urolithiatic effect of Delonix regia leaves in ethylene glycol and ammonium chloride induced urolithiasis in wistar rats. Renal stone was induced in animals by 0.75% ethylene glycol and 1 % ammonium chloride in drinking water for 28 days. In this study the test groups animals were administered with ethanolic extract of D.Regia at doses 200mg/kg and 400mg/kg once in day from 15th day to 28th day. Cystone (75mg/kg) was used as standard drug. In this study in vitro crystallization is done by using nucleation assay and aggregation assay by using calcium chloride and sodium oxalate. The effect of Delonix regia on various physical and biochemical parameters in urine as well as serum was evaluated. The present study, results reveals that the administration of 400mg/kg dose of Delonix regia reduced the biochemical parameter than 200mg/kg and states that higher dose is an effective dose for treatment of urolithiasis.

Could combination chemotherapy be more effective than monotherapy in the treatment of visceral leishmaniasis? A systematic review of preclinical evidence.

From a systematic review framework, we assessed the preclinical evidence on the effectiveness of drug combinations for visceral leishmaniasis (VL) treatment. Research protocol was based on the PRISMA guideline. Research records were identified from Medline, Scopus and Web of Science. Animal models, infection and treatment protocols, parasitological and immunological outcomes were analysed. The SYRCLE's (SYstematic Review Center for Laboratory Animal Experimentation) toll was used to evaluate the risk of bias in all studies reviewed. Fourteen papers using mice, hamster and dogs were identified. Leishmania donovani was frequently used to induce VL, which was treated with 23 drugs in 40 different combinations. Most combinations allowed to reduce the effective dose, cost and time of treatment, in addition to improving the parasitological control of Leishmania spp. The benefits achieved from drug combinations were associated with an increased drug's half-life, direct parasitic toxicity and improved immune defences in infected hosts. Selection, performance and detection bias were the main limitations identified. Current evidence indicates that combination chemotherapy, especially those based on classical drugs (miltefosine, amphotericin B antimony-based compounds) and new drugs (CAL-101, PAM3Cys, tufisin and DB766), develops additive or synergistic interactions, which trigger trypanocidal and immunomodulatory effects associated with reduced parasite load, organ damage and better cure rates in VL.

Research results on the use of plant growth regulator Triacontanol in winter wheat crops in the conditions of the Lower Volga region

To determine of the most effective dose of Triacontanol treatment for foliar cultivation of crops in the tillering and heading phases of winter wheat and its effect on yield and grain quality. Triacontanol is a natural plant growth regulator capable of increasing crop yields, their growth by accelerating photosynthesis, protein biosynthesis. Make an analysis of the influence of different doses of Triacontanol on the duration of the phases of development of winter wheat. Reach the determination of the effect of different doses of Triacontanol on the yield and quality of winter wheat grain. The data on the study and determination of the most effective dose of Triacontanol treatment for foliar cultivation of crops in the tillering and heading phases of winter wheat and its effect on yield and grain quality are presented. Triacontanol is a natural plant which has growth regulator capable of increasing crop yields, their growth by accelerating photosynthesis, protein biosynthesis; The doses of Triacontanol and their effect on the duration of the phases of development of winter wheat have been determined; The influence of various doses of Triacontanol on the yield and grain quality of winter wheat has been established. The stages of tillering-earing development were chosen, because during this period, active development of plants takes place: the formation of main and lateral stems, the development of the vegetative mass and generative organs of wheat, therefore it is important and necessary to support their growth and development.

Amoxicillin Treatment of Children With Community-Acquired Pneumonia

Amoxicillin Treatment of Children With Community-Acquired Pneumonia

COVID-19 convalescent plasma: Evolving strategies for serological screening in France.

Quantitation of anti-SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) neutralizing antibodies (Nabs) is a key parameter in determining the effective dose for treatment with COVID-19 convalescent plasma (CCP). Interpretation of results from clinical trials conducted worldwide requires comparison of Nabs titres obtained from different methods. As virus neutralization tests (VNTs) are not standardized scalable or commercially available, strategies based on intensity of ELISA (Enzyme Linked Immunosorbent Assay) or chemiluminescent binding serological tests were implemented to allow comparisons and establish criteria for determining 'high-titres' of anti-SARS-CoV-2 antibodies (Abs). To this end, the FDA (Food and Drug Administration) has proposed criteria to define high-titre plasmas using different serological assays, including the one used in France for the CCP SARS-CoV-2 Abs screening (Euroimmun anti-S1 IgG). A retrospective study revealed that when using the FDA criteria (ELISA signal-to-cut-off [S/C ratio] ≥3.5), 91% of CCP had Nabs titres ≥40 as assessed with an in-house VNT. French strategy to ensure sufficient stocks of CCP of increasing titre has evolved over time. Recently, we improved our strategy by collecting only plasma from vaccinated convalescent donors as we confirmed that the mean IgG antibody level (ELISA S/C ratio) was significantly higher in plasma from vaccinated convalescent donors compared to donations from unvaccinated convalescent donors: 9.31 (CI 95%: 8.46-10.16) versus 3.22 (CI 95%: 3.05-3.39) (p < 0.001).

Online Telehealth Delivery of Group Mental Health Treatment Is Safe, Feasible, and Increases Enrollment and Attendance in Post-9/11 U.S. Veterans

Post-9/11 U.S. veterans are clinically complex with multiple co-occurring health conditions that lead to increased morbidity and mortality, risk for suicide, and decreased quality of life, but underutilization and resistance to treatment remain significant problems. Increased isolation and decreased community and social support due to coronavirus disease (COVID-19) have exacerbated mental health risk. This study evaluated the safety and feasibility of home-based telemental health group workshops to improve reintegration and social connection in post-9/11 U.S. military personnel. Seventy-four (61 males/13 females) post-9/11 U.S. military veterans were randomized to receive 12 sessions of STEP-Home cognitive-behavioral group workshop or present-centered group therapy. Treatment was delivered either in person (traditional medical center setting, treatment as usual [TAU]), or via home-based synchronous videoconferencing (VC). The change to VC occurred due to social distancing guidelines during COVID-19. Mean age was 41.0 years (SD = 11.5, range 24–65). Forty-five (36 males/9 females) participated in VC and 29 (25 males/4 females) in TAU. Demographics were similar across treatment milieu. There were no differences in therapist treatment adherence for TAU versus VC. Therapist satisfaction was higher for TAU groups (q value < .05). Veterans showed higher enrollment, attendance, group cohesion, and veteran-to-veteran support for VC compared to TAU (q values < .05). Safety procedures were successfully implemented via VC. Results demonstrate the safety, feasibility, and high satisfaction of group telemental health in U.S. veterans. Higher enrollment and treatment adherence for telemental health delivery resulted in a greater likelihood of receiving an effective treatment dose than TAU. Strong group cohesion and veteran-to-veteran support were achievable via telehealth. Telemental health offers convenient, efficient, and cost-effective care options for veterans and may be particularly helpful for patients with high psychiatric burden.

Dr. Edith H. Quimby: A pioneering medical physicist and educator with outstanding contributions in radiation dosimetry

Dr. Edith H. Quimby: A pioneering medical physicist and educator with outstanding contributions in radiation dosimetry

The Effect of Parenting Programme on the Symptoms and the Family Functioning of Children with Attention Deficit and Hyperactivity Disorder Who Have Residual Symptoms Despite Medical Treatment

AbstractThis study aims to determine the effects of the Parents Plus Children's Programme (PPCP) on children's symptoms of attention deficit and hyperactivity disorder (ADHD) and on family functionality and parenting stress. The children in the study were aged 6–11 years, and they had been diagnosed with ADHD and had residual symptoms despite effective dosage and timing of their medication. Forty-six couples, who with their children met the eligibility criteria, were enrolled and randomly allocated to the PPCP or the control group. The intervention involved a 9-week, 2 h a week, parenting group exercise. Those in the PPCP group improved significantly more over time on Conners’ Parent Rating Scale-Revised, Family Assessment Device, and Parent Stress Index than those in the control condition. The trial is the first clinical study involving the parents of children with ADHD that addresses residual symptoms and functional impairments that remain despite the administration of the maximum effective dose of pharmacological treatment.

Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study

Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings.

Biological Effective Dose for Treatment of a Heterogeneous Population of Cells with a Spread-Out Bragg Peak of Particle Radiation.

Calculation of the biological effective dose (BED) of a fractionated course of hadron particle radiation (e.g., protons or carbon ions) administered via a spread-out Bragg peak (SOBP) to a population of cells with heterogeneous radiosensitivity is described. The calculated BED has the important property that, if equal to that of a course of photon radiation, the particle course will result in the same fraction of cells of the exposed population that survive and can be expected to have the same clinical effect. The calculated BED provides a way to relate the effect of a planned treatment course with particle radiation to clinical experience of the effects of treatment with low-LET photon radiation.

Dose\u2013response effects of light therapy on sleepiness and circadian phase shift in shift workers: a meta-analysis and moderator analysis

Light therapy has been considered to be effective in mitigating sleepiness and regulating circadian phase shift in shift workers. However, the effective treatment dose of light therapy remains undetermined. We performed a meta-analysis of randomized experimental studies to determine the effect of light therapy doses on sleepiness and circadian phase shift in shift workers. An article search was performed in 10 electronic databases from inception to June 2020. Two raters independently screened and extracted data and reached consensus. Twenty-one eligible studies were included. Analyses were performed using random-effects models. Light therapy exerted significantly small to medium effects on sleepiness and large treatment effects on circadian phase shift. Moderator analyses performed with subgroup and metaregression analyses revealed that medium-intensity light therapy for a shorter duration more effectively reduced sleepiness at night, whereas higher-intensity light therapy more effectively induced phase shifting, but the required treatment duration remained inconclusive. This study provides evidence regarding the effect of light therapy in reducing sleepiness and shifting circadian phase in shift workers. Exposure to medium-intensity light for a short duration at night reduced sleepiness, whereas exposure to high-intensity light improved sleep by shifting their circadian phase.

Effective Dose of Rhizoma Coptidis Extract Granules for Type 2 Diabetes Treatment: A Hospital-Based Retrospective Cohort Study.

Rhizoma Coptidis is a popular phytomedicine for the treatment of type 2 diabetes in Asia, but its effective dose for diabetes treatment remains confused because of diverse origins. This study aimed to investigate the dose-response effects of Rhizoma Coptidis extract granules (RCEG), produced with standardized quality control, on hypoglycemic effects in patients with type 2 diabetes. We conducted a retrospective analysis of Chang Gung Research Database from January 01, 2008 to November 30, 2017. Outpatients visiting traditional Chinese medicine clinics and receiving RCEG for type 2 diabetes treatment were included. Plasma glucose, lipid, and other parameters were analyzed from 93 patients with a total of 737 visits within 60 weeks. Scatter plots with the LOESS analysis were used to explore the association between RCEG dose and hypoglycemic effect. The minimal effective dose was chosen to divide the study population into the high-dose and low-dose RCEG groups. Non-parametric tests were used for between-group and within-group comparisons. The multivariate nonlinear mixed-effects model was applied to access the effect of treatment length and groups simultaneously on the change of HbA1c and fasting plasma glucose. The “arule” package in R was used to present the network diagram of RCEG and other co-prescriptions. We first discovered a significant relationship between RCEG dose and HbA1c reduction when the dose reached 0.08 g/kg/day or higher. We thus defined 0.08 g/kg/day of RCEG as the minimum effective dose, and a threshold to separate patients into the high-dose (≥0.08 g/kg/d) and low-dose (<0.08 g/kg/d) RCEG groups. In the high-dose RCEG group, a significant decrease in total cholesterol and a trend toward triglyceride reduction were also noted. Patients more effectively responded to RCEG treatment if they had a higher initial HbA1c level, higher heart rates, better liver function tests, and better tolerance to the higher dose and treatment duration of RCEG. In addition, digestive/tonic/dampness draining formulas and blood regulation recipes were two of the most frequent co-prescriptions with RCEG. This study concluded that RCEG at a dose exceeding 0.08 g/kg/d had beneficial effects on glycemic and lipid control, without showing nephro- or hepatotoxicity, in patients with type 2 diabetes.

Demonstration of treatment planning software for hyperthermic intraperitoneal chemotherapy in a rat model

Background Hyperthermic intraperitoneal chemotherapy (HIPEC) is administered to treat residual microscopic disease after cytoreductive surgery (CRS). During HIPEC, fluid (41–43 °C) is administered and drained through a limited number of catheters, risking thermal and drug heterogeneities within the abdominal cavity that might reduce effectiveness. Treatment planning software provides a unique tool for optimizing treatment delivery. This study aimed to investigate the influence of treatment-specific parameters on the thermal and drug homogeneity in the peritoneal cavity in a computed tomography based rat model. Method We developed computational fluid dynamics (CFD) software simulating the dynamic flow, temperature and drug distribution during oxaliplatin based HIPEC. The influence of location and number of catheters, flow alternations and flow rates on peritoneal temperature and drug distribution were determined. The software was validated using data from experimental rat HIPEC studies. Results The predicted core temperature and systemic oxaliplatin concentration were comparable to the values found in literature. Adequate placement of catheters, additional inflow catheters and higher flow rates reduced intraperitoneal temperature spatial variation by −1.4 °C, −2.3 °C and −1.2 °C, respectively. Flow alternations resulted in higher temperatures (up to +1.5 °C) over the peritoneal surface. Higher flow rates also reduced the spatial variation of chemotherapy concentration over the peritoneal surface resulting in a more homogeneous effective treatment dose. Conclusion The presented treatment planning software provides unique insights in the dynamics during HIPEC, which enables optimization of treatment-specific parameters and provides an excellent basis for HIPEC treatment planning in human applications.

A randomized clinical trial on improving osteopenia in postmenopausal women after two years of preventive treatment with alendronate; a dose of 35 mg per week is more effective or a dose of 70 mg?

Introduction: Osteoporosis is the most common metabolic bone disease worldwide. In this disease, the bone mass decreases and as it progresses, the risk of fracture increases. Osteopenia occurs in the early stages of bone loss. Studies on the effective dose for treatment of osteopenia have been controversial. Objectives: In this randomized clinical trial, low doses versus high doses of alendronate were assessed during the osteopenic stage in postmenopausal women. Patients and Methods: The present study is a randomized clinical trial (RCT) that was performed on 152 postmenopausal women who were visited in Al-Zahra rheumatology clinic between 2016 and 2017. Patients were randomly divided into two groups. The first group with 35 and the second group with 70 mg of weekly alendronate were treated and followed for two years. Densitometry was performed on patients before and 2 years after the intervention, and the findings were compared. Results: The two groups were not significantly different in terms of age, gender, height, weight, body mass index (BMI) and menopause (P&gt;0.05). The bone mineral density (BMD) findings of both groups, including Fracture Risk Assessment Tool (FRAX) hip and vertebra/wrist, T-score hip and vertebrae, as well as Z-score hip and vertebrae, improved significantly after two years (P&lt;0.001), However, a comparison of the two therapeutic doses did not show a significant difference in terms of BMD improvements (P&gt;0.05). Conclusion: The findings of this study reported favorable results for the preventive treatment of alendronate in osteopenic women. In addition, due to gastrointestinal problems that are the main complaint of alendronate use, according to the results, a weekly dose of 35 mg can be recommended