Effects Of Different Treatment Modalities Research Articles

Evaluation of the effects of different treatment modalities on angiogenesis in heart failure patients with preserved ejection fraction via VEGF and sVEGFR-1

Abstract Objective In this study, our aim was to investigate the clinical significance of VEGF, sVEGFR-1 in HFpEF patients. Materials and methods Seventy-two participants enrolled in this cross-sectional case-control study including HFpEF patients (n=41) and healthy (n=31) subjects. Blood samples were collected and serum VEGF, sVEGFR-1 analysis, and transthoracic echocardiography were performed. Results and discussion The average sVEGFR-1 level of HFpEF patient group was significantly higher than the control group (respectively 0.136 ng/L (0.04–0.34), 0.06 ng/L (0.01–0.25); p<0.001). The average VEGF level of HFpEF patients using beta blocker was significantly higher than the HFpEF patients not using it (respectively 0.585±0.194 ng/L; 0.349±0.269 ng/L; p=0.025). The average VEGF level of HFpEF patients using statins was significantly higher than the HFpEF patients without a medication (respectively 0.607±0.099 ng/L; 0.359±0.273 ng/L; p=0.038). Conclusion Our study is the first study demonstrating the relations among HFpEF, accompanying morbidities, VEGF and sVEGFR-1 levels. Statins and beta blockers may have positive effects on angiogenesis in HFrEF patients via increasing VEGF levels.

Adverse Cochlear Effects After Head and Neck Cancer Therapy.

This study aims to report the incidence of adverse cochlear effects when treating patients of HNSCC with different radiation techniques and to compare the effect of different treatment modalities on the cochlea. This prospective observational study took place in a tertiary care centre, of 132 individual ears from 66 patients of HNSCC treated with conventional RT (group-1), IMRT (group-2), conventional RT with chemotherapy (group-3) and IMRT in combination with chemotherapy (group-4). Pure tone audiometry was performed during the follow-up period at 3months and 1year of completion of therapy. Correlation of audiometric change of both the ears at high frequencies (pure tone average 4kHz, 6kHz, 8kHz), low frequencies (pure tone average 0.5-2kHz) and BC (average 500-4kHz) with series of factors were analyzed. There was a significant deterioration of hearing threshold 1year after complete treatment, in all groups. There was an average drop in BC (0-1year) by 19.63 ± 31.25% in group-2, 24.57 ± 21.96% in group-1 and a drop of 36.48 ± 43.97% and 70.78 ± 21.11% in group-3 and group-4 respectively. When we compared the audiometric change (PTAv at high and low frequency) from 0 to 1year of group-1&2 the p value was significant (p = 0.050 at high frequency, p = 0.040 at low frequency). The audiological outcome of the different treatment modalities when compared, it was observed that the maximum hearing loss was in group-4 (IMRT with Chemotherapy) followed by group-3 (RTCT), group-1 (Conventional RT) and group-2 (IMRT).

Evaluation of the effects of different treatment modalities on angiogenesis in heart failure patients with reduced/mid-range ejection fraction via VEGF and sVEGFR-1.

Objectives:To investigate the clinical significance of VEGF, sVEGFR-1 in heart failure reduced ejection fraction (HFrEF) and heart failure mid-range ejection fraction (HFmrEF) patients.Methods:A total of 104 people consisting of HFrEF and HFmrEF patients (n=54) and healthy (n=50) subjects were included in this comparative cross-sectional study. The study took place in Gulhane Training and Research Hospital, Ankara, Turkey, between 2011 and 2013. Serum VEGF, sVEGFR-1, plasma pro-BNP analysis and transthoracic echocardiography were performed.Results:The average sVEGFR-1 level of the HFrEF and HFmrEF patients was significantly higher than the control group (0.185±0.122; 0.141±0.120; p=0.013). The average sVEGFR-1 level of the HFrEF and HFmrEF patients using beta-blocker was significantly higher than the HFrEF and HFmrEF patients not using it (p=0.015). There was a significant and positive correlation between sVEGFR-1 and N-terminal pro-brain natriuretic peptide (pro-BNP) levels in the group with HF (r=0.211, p=0.044).Conclusion:It increases awareness about the role of sVEGFR-1 in HFrEF anf HFmrEF patients and the need for further studies. Beta-blocker may have a negative effect on angiogenesis in HFrEF and HFmrEF via increasing sVEGFR-1 levels. Additionally, Pro-BNP may contribute to inhibiting angiogenesis by increasing sVEGFR-1 levels and sVEGFR-1 may be an important biomarker in HFrEF and HFmrEF.

Quality of life in oropharyngeal cancer: a structured review of the literature.

To summarize the literature on quality of life (QoL) in patients with oropharyngeal squamous cell carcinoma (OPSCC). The PubMed database was searched using the inclusion criteria "oropharyngeal cancer," "quality of life," "human," and "English," the exclusion criterion "recurrent," and publication date between January 1, 2005 and October 26, 2015. The search yielded 98 articles of which 17 fulfilled all selection criteria. Intensity-modulated radiotherapy (IMRT) showed a better outcome for several QoL domains and was superior to chemoradiotherapy (CRT) in some studies. At 12-month follow up, deterioration of QoL was seen in a smaller proportion of patients after surgery and postoperative radiotherapy (S&PORT) in comparison to CRT. For all treatment modalities, the most important worsening for several QoL domains was seen at 3months. Stage III/IV patients experienced a greater deterioration of QoL scores for most scores. No consistent results were reported for the correlation between xerostomia assessed with QoL questionnaires and objective swallowing function assessed with modified barium swallow videofluoroscopy. The different tools used for the assessment of patient-reported QoL and objective measurement of functional outcome make it difficult to evaluate the effect of different treatment modalities. In general, we can conclude that a non-surgical approach is associated with worse QoL scores. IMRT minimizes radiation to the surrounding tissue and therefore has a better outcome in several QoL domains in comparison to conventional RT.

Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis.

IntroductionLaryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment.ObjectiveTo describe the effectiveness of different treatment modalities for primary or recurrent laryngeal granulomas resulting from endotracheal intubation.MethodsSystematic review and proportional meta-analysis. Eligibility criteria – experimental or observational studies with at least five subjects. Outcomes studied – granuloma resolution, recurrence, and time for resolution. Databases used – Pubmed, Embase, Lilacs, and Cochrane. The Stats Direct 3.0.121 program was used.ResultsSix studies were selected, with 85 patients. The treatments registered were: antireflux therapy, speech therapy, anti-inflammatory drugs, steroids, antibiotics, zinc sulfate and surgery. 85 patients from six studies had primary treatment: surgery ± associations (41 patients), resolution chance 75% (95% CI: 0.3–100%, I2 = 90%), absolute relapse risk 25% (95% CI: 0.2–71%); medical treatment (44 patients), resolution chance 86% (95% CI: 67–97%); and absolute relapse risk 14% (95% CI: 3–33%). There was no significant difference between groups. Three studies, encompassing 19 patients, analyzed secondary treatment (failure or recurrence after primary treatment); three subjects presented new recurrence. The time needed to resolve the lesions varied from immediate, after surgery, to 23 months, for inhaled steroid.ConclusionThere is no evidence of high quality that proves the efficacy of any treatment for laryngeal granulomas resulting from endotracheal intubation.

Effect of Different Treatment Modalities for End-stage Renal Disease After Heart Transplantation

End-Stage Renal Disease (ESRD) is a frequent complication of heart transplantation (HTx). The aim of this study was to determine the long-term incidence of ESRD and to investigate what subsequent therapy showed the best survival.

The Effectiveness of Different Treatment Modalities for the Management of Ocular Injuries Following Sulfur Mustard Exposure

Background: Mustard gas or sulfur mustard (dichloro-3-thiapentane-1,5) is a chemical compound consisting of chlorine and sulfur which was used as a chemical weapon in the First World War and during the war between Iran and Iraq. Mustard gas is a lipophilic compound that is highly poisonous and can quickly penetrate into body tissues. Eye is one of the body organs that is quite vulnerable to this compound. The present study was conducted to review the effectiveness of various treatments for ocular injuries caused by sulfur mustard. Methods: In this review, therapeutic effects of anti-inflammatory drugs such as dexamethasone, diclofenac, betamethasone and their combination, as well as surgical interventions based on stem cells and different methods of keratoplasty [e.g. penetrating keratoplasty (PKP), lamellar keratoplasty (LKP), and deep anterior lamellar keratoplasty (DALK)] were assessed. Results: As the results indicated, combinatorial therapeutic approaches are more successful compared with single therapeutic measures. It has been reported that utilization of anti-inflammatory drugs such as diclofenac, dexamethasone and betamethasone can control the initial symptoms. In addition, keratolimbal allograft stem cell transplantation methods along with LKP and PKP keratoplasty methods can lead to considerable therapeutic success. Conclusion: Considering the involvement of multiple abnormalities in the pathogenesis of sulfur mustard-induced chronic ocular complications, combinatorial therapeutic approaches appear to be more efficacious.

Evaluating Treatment Patterns for Small Cell Carcinoma of the Colon Using the National Cancer Database (NCDB).

The objective of this study was to characterize the clinicopathological prognostic factors and treatment patterns for small cell carcinoma (SCC) of the colon, a rare disease without standard treatment guidelines. We analyzed clinicopathological and treatment variables for 503 cases of histologically proven SCC colon entered into the National Cancer Database (NCDB) between 2004 and 2013. Survival curves were generated using Kaplan-Meier and compared by the log-rank test. Cox proportional hazard regression was used to control for covariates and evaluate the effect of different treatment modalities on overall survival. Four hundred seventy-two (93.8%) patients had complete clinical staging information and were therefore included in our analysis. Of these patients, 149 (31.5%) had limited stage disease (LD) and 323 (68.4%) had extensive stage disease (ED) at presentation. Median overall survival (OS) for patients with ED was significantly lower than for those with LD (4.04months vs. 21.82months; p < 0.001). Multivariate Cox regression analysis showed administration of chemotherapy was associated with improved survival in patients with LD and ED (p = 0.026, p < 0.001) while surgery was not associated with improved survival in patients with LD or ED (p = 0.943, p = 0.630). Radiation therapy was associated with improved survival in patients with ED (p = 0.044). SCC of the colon carries a poor prognosis, especially in patients presenting with metastatic disease. Surgery and chemotherapy are administered more frequently than radiation, and chemotherapy is associated with improved survival, unlike surgery.

Treatment possibilities for low anterior resection syndrome: a review of the literature.

Up to 80% of patients after low anterior resection, experience (low) anterior resection syndrome (ARS/LARS). However, there is no standard treatment option currently available. This systemic review aims to summarize treatment possibilities for LARS after surgical treatment of rectal cancer in the medical literature. Embase, PubMed, and the Cochrane Library were searched using the terms anterior resection syndrome, low anterior resection, colorectal/rectal/rectum, surgery/operation, pelvic floor rehabilitation, biofeedback, transanal irrigation, sacral nerve stimulation, and tibial nerve stimulation. All English language articles presenting original patient data regarding treatment and outcome of LARS were included. We focused on the effects of different treatment modalities for LARS. The Jadad score was used to assess the methodological quality of trials. The quality scale ranges from 0 to 5 points, with a score ≤ 2 indicating a low quality report, and a score of ≥ 3 indicating a high quality report. Twenty-one of 160 studies met the inclusion criteria, of which 8 were reporting sacral nerve stimulation, 6 were designed to determine pelvic floor rehabilitation, 3 studies evaluated the effect of transanal irrigation, 2-percutaneous tibial nerve stimulation, and the rest of the studies assessed probiotics and 5-HT3 receptor antagonists for LARS in patients who had undergone rectal resection. All except one study were poor quality reports according to the Jadad score. LARS treatment still carries difficulties because of a lack of well-conducted, randomized multicenter trials. Well-performed randomized controlled trials are needed.

Clinical and laboratory evaluation of the effects of different treatment modalities on titanium healing caps: a randomized, controlled clinical trial

The objective of this study is to evaluate the effects of treatment modalities on titanium surface characteristics and surrounding tissues. Eighteen participants each had four titanium healing caps (HC) attached to four newly inserted implants. After healing, each HC was randomly assigned to either (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) only rubber cup polishing (CON). Probing depths (PD), bleeding on probing (BOP), matrix metalloproteinase 8 (MMP-8), and periopathogens were recorded before and 3months following instrumentation. After final assessments, HCs were removed, cleaned, and subjected to (a) bacterial colonization (Streptococcus gordonii, 24h; mixed culture, 24h) and (b) gingival fibroblasts (5days). HC surfaces were analyzed with a scanning electron microscope (SEM). No significant differences between the groups were evident before or after instrumentation for PD and BOP (except TC showed a significant decrease in PD; p = 0.049). MMP-8 levels and bacterial loads were always very low. MMP-8 decreased further after instrumentation, while bacteria levels showed no change. No significant differences (p > 0.05) were evident in bacterial colonization or fibroblast attachment. A comparison of the overall mean SEM surface roughness scores showed a significant difference between all groups (p < 0.0001) with the lowest roughness after EP. All treatments performed yielded comparable outcomes and may be implemented safely. Clinicians may fear implant surface damage, but all instrumentation types are safe and non-damaging. They can be implemented as needed upon considering the presence of staining and soft and hard deposits.

172 Additional Therapies to Surgery in Adult Patients with Malignant Peripheral Nerve Sheath Tumors (MPNSTs)

Abstract INTRODUCTION Malignant peripheral nerve sheath tumors (MPNSTs) constitute a group of rare neoplasms with an estimated 5-year survival between 16 and 52%. Currently, there is disagreement on survival benefit of additional therapies to surgery in patients with MPNSTs. The aim of the present study is to determine predictors of receiving additional therapies and to evaluate the effect of different treatment modalities on overall survival. METHODS The National Cancer Database was queried for the years 2004 to 2014 for patients with MPNSTs, aged 18 and above, with no metastases at diagnosis. Patients were stratified by clinical stage (low-1/2, high-3/4). Multivariable regression analyses were performed after controlling for age, sex, comorbidity, tumor size, site, and grade. Predictors of additional therapies were evaluated in an intention-to-treat analysis. RESULTS &gt;We identified a total of 2914 patients; 52.8% received surgery alone, 31.8% received additional radiation, 5.2% additional systemic therapy, and 10.2% received both. Predictive models showed greater odds of having additional therapies for patients with high tumor grade (O.R. 2.88, 95% C.I. 2.02-4.12), tumor size &gt;5 cm (O.R. 2.55, 95% C.I. 1.85-3.52), and high stage disease (O.R. 1.73, 95% C.I. 1.19-2.52). In patients with low-stage disease, additional systemic therapy (H.R. 2.25, 95%CI 1.31-3.36) as well as additional radiation and systemic therapy were associated with higher mortality hazard (H.R. 2.02, 95% C.I. 1.29-3.16). In patients with high-stage disease, additional radiation with (HR 0.60, 95% C.I. 0.40-0.90) or without systemic therapy (H.R. 0.68, 95%CI 0.47-0.97, P = 0.034) was associated with lower overall mortality hazard. CONCLUSION Patients with high grade tumors, larger tumors, and high stage disease were likely to have both radiation &amp; systemic therapies recommended. Only radiation was associated with a survival benefit in patients with high stage disease. In other patients, additional therapies were associated with no benefit or even poorer survival.

Effect of postoperative adjuvant therapy on the prognosis of patients with stage pT3N0M0 thoracic esophageal squamous cell carcinoma: a preliminary analysis

Objective To determine the prognostic factors in patients with stage pT3N0M0 thoracic esophageal squamous cell carcinoma (TSCC) after esophagectomy, and to compare the effects of different treatment modalities on the prognosis of patients. Methods A retrospective analysis was conducted on 480 patients with stage pT3N0M0 TSCC from 2007 to 2010 to determine the prognostic factors in the patients, and to compare the effects of different treatment modalities on their prognosis. Survival rate was calculated using the Kaplan-Meier estimator, and multivariate analysis of prognostic factors was performed using the Cox model. Results Of the 439, 333, and 278 patients who completed the 1-, 3-, and 5-year follow-up, respectively, the 1-, 3-, and 5-year overall survival (OS) rates were 90.0%, 68.7%, and 57.9%(median 87 months, 95% confidence interval (CI=74.7-99.4), respectively, and the 1-, 3-, and 5-year disease-free survival (DFS) rates were 82.3%, 60.4%, and 52.3%(median 71.3 months, 95%CI=55.1-87.5), respectively. In order to account for the different constituent ratios of some clinical and pathological data between the three groups of patients, 55 patients in each group were matched using propensity score matching (PSM)(all P>0.05). It was found that the post-PSM 1-, 3-, and 5-year OS and DFS were significantly different between patients who received surgery only, postoperative chemotherapy (POCT), and postoperative chemoradiotherapy/radiotherapy (POCRT/RT)(P=0.000 and 0.006, respectively). Multivariate Cox analysis showed that age, lesion location, and treatment modality were independent prognostic factors for OS and DFS (P=0.029, 0.004, 0.000 and P=0.009, 0.003, 0.002), and the length of lesion was also an independent prognostic factor for DFS (P=0.003). Conclusions Although the rate of post-operative treatment failure is still high among patients with stage pT3N0M0 TSCC, POCRT/PORT can improve the prognosis and the 5-year OS and DFS of these patients. However, further large-sample prospective studies will be required to confirm these findings. Key words: Esophageal neoplasms/surgery; Esophageal neoplasms/postoperative radiotherapy; Esophageal neoplasms/postoperative chemotherapy; Prognosis

Mo1225 - The Effect of Different Treatment Modalities on the Survival of Patients with Linitis Plastica

Mo1225 - The Effect of Different Treatment Modalities on the Survival of Patients with Linitis Plastica

Systematic review on management of perioperative iatrogenic injury of distal common bile duct

Objective To study the effectiveness of different treatment modalities for iatrogenic injury of distal common bile duct during operation. Methods We browsed Chinese Medical Full-text Database with the term ofdistal common bile duct All the clinical studies associated with perioperative latrogenic injury of distal common bile duct and adjacent tissue published after 1990 were enrolled, and we collected the clinical data, mortality and reoperation rate with different treatments for analysis. Results Thirty-four case series and case reports with 233 patients were included. 14 patients with isolated duodenal injury were excluded. The overall mortality of the remaining 219 patients was 9.6%, and the reoperation rate was 17.4%. A total of 145 patients who were diagnosed with distal common bile duct injury during and after operation from 21 articles were compared. The mortality and reoperation rate were both 1.9% among 106 patients who were diagnosed during operation. The figures were 43.6%, and 84.6% among 39 patients who were diagnosed after operation, respectively. In 9 articles with 46 patients, the clinical outcomes of 21 patients who were treated by intraoperative suture was compared with 25 patients who underwent enhanced biliary and retroperitoneal drainage. The mortality and reoperation rates were 0 in both groups. Conclusions Early detection and management are crucial to perioperative common bile duct injury. Furthermore, no significant difference of clinical outcomes observed between bile drainage and perforation suture groups. Key words: Common bile duct injury; Distal common bile duct; Latrogenic injury; Bile drainage; Perforation suture

Comparison of different treatment modalities in patients with esophageal carcinoma received intensity-modulated radiotherapy

Objective To investigate long-term efficacy in patients with esophageal carcinoma received different intensity-modulated radiotherapy (IMRT) modalities, and to analyze the reasons for treatment failure. Methods A total of 349 esophageal cancer patients was analyzed in the study. The cases who underwent IMRT only, IMRT with concurrent chemotherapy and IMRT followed by sequential chemotherapy was 169 (48.4%), 121 (34.7%), and 59 (16.9%), respectively. The short-term efficacy, acute toxicity, 1-, 3-, 5-year local control and survival rates in three different treatment strategy were evaluated. The effect of different treatment modalities on local control and survival was analyzed, meanwhile side-effects were observed, and treatment failure reason was also analyzed. Results The 1-, 3- and 5-year survival rates were 72.7%, 46.0%, and 35.9% in concurrent chemoradiotherapy group, while 64.4%, 35.1%, and 24.3% in sequential chemoradiotherapy group, and 62.7%, 36.1%, and 17.2% in IMRT only group. The 1-, 3- and 5-year survival rates in concurrent chemo-radiotherapy were improved when compared to those in radiotherapy only (χ2=5.631, P=0.018). The 1-, 3- and 5-year local controlled rates were 76.2%, 67.3%, and 60.9% in concurrent chemoradiotherapy group, 74.9%, 49.2%, and 46.9% in sequential chemoradiotherapy group, and 70.4%, 59.7%, and 51.3% in radiotherapy only group. There was no significant difference among three groups (χ2=2.569, P=0.277). The acute rate of hematologic toxicity was increased when IMRT combined with chemotherapy versus radiotherapy only (χ2=42.550, P=0.000). The bone marrow suppression rate ≥ grade II in concurrent chemoradiotherapy group was 47.9% (58/121), and 42.4% (25/59) in sequential chemoradiotherapy group, and 16.6% (28/169) in radiotherapy only group It showed that FP regimen and TP regimen had the similar efficacy both in local control and suuvival (χ2=0.108, P=0.742; χ2=0.004, P=0.948). Conclusions Comparing IMRT only group, the long-term survival rates in IMRT with concurrent chemotherapy are increased significantly, while sequential chemoradiotherapy group has no advantage, so the latter is not recommended. Chemoradiotherapy strategy increases the risk of acute hematologic toxicity when compared to that in radiotherapy only. There is no significant difference in efficacy between FP and TP regimen. Key words: Esophageal neoplasms/RT; Radiotherapy, intensity-modulated/MT

Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders.

The global prevalence in the use of opiates and opioids has remained stable, though there were some unprecedented recent increases in opioid use and associated mortality and morbidity in the United States. Internationally, there is a strong tendency for consolidation of drug treatment strategies in favor of more systematic, structured and balanced approaches to regional and national drug policies. However, there are considerable differences in the scope, focus, and implementation of national drug policies and the political context is shaping drug prevention, treatment and rehabilitation efforts to an extent not typically observed in other public health domains. As a result, though in theory, there is a considerable multi-national agreement about the efficacy and effectiveness of different treatment modalities for opioid dependence, in practice, there are striking differences among different world regions and countries in the degree of implementation of these treatment modalities into clinical practice. Such discrepancies between theory and practice are observed even in high-income countries such as the United States and European Union member states, where evidence-based treatment modalities are still not well implemented into clinical practice. Despite the lack of evidence-based support for the role of detoxification as a stand-alone treatment for opioid use disorders, it appears to be the most widely used intervention for opioid use across the world.

Health-related quality of life and emotional problems in children surviving brain tumor treatment: A descriptive study of 2 cohorts

ABSTRACTThe survival of childhood brain tumors has improved in the past 30 years, but acquired brain injury due to damage caused by tumor invasion and side effects of different treatment modalities frequently occurs. This study focused on residual impairments, health-related quality of life (HRQoL), and emotional and behavioral problems in 2 cohorts of survivors diagnosed and treated for various types of brain tumors. Survivors in the 2004 cohort visited the Erasmus Medical Centre for standardized follow-up between 2003 and 2004, and in the 2014 cohort, between 2012 and 2014. Data of neurologically impairments of all children were extracted from medical records. Parents and survivors filled out questionnaires on quality of life and emotional and behavioral problems. In both cohorts, approximately 55% of the survivors displayed neurologic impairments. In comparison with the healthy reference group, a reduced parent-reported quality of life was found on the Motor, Cognition, and Autonomy (Cohort 2004) scales. Comparison between the cohorts showed that parents in the 2004 cohort reported a higher HRQoL on the Motor and Cognitive functioning scales. In the 2014 cohort, children reported less negative emotions than healthy children. No increase in emotional or behavioral problems were reported by children in both cohorts, whereas parents reported problems in social functioning and isolation related to a delay in emotional development. Children surviving brain tumor treatment have a reduced quality of life. The authors therefore recommend regular screening of HRQoL and emotional and behavioral problems and referral to specific aftercare.

Using Micro-computed Tomography for the Assessment of Tumor Development and Follow-up of Response to Treatment in a Mouse Model of Lung Cancer.

Lung cancer is the most lethal cancer in the world. Intensive research is ongoing worldwide to identify new therapies for lung cancer. Several mouse models of lung cancer are being used to study the mechanism of cancer development and to experiment with various therapeutic strategies. However, the absence of a real-time technique to identify the development of tumor nodules in mice lungs and to monitor the changes in their size in response to various experimental and therapeutic interventions hampers the ability to obtain an accurate description of the course of the disease and its timely response to treatments. In this study, a method using a micro-computed tomography (CT) scanner for the detection of the development of lung tumors in a mouse model of lung adenocarcinoma is described. Next, we show that monthly follow-up with micro-CT can identify dynamic changes in the lung tumor, such as the appearance of additional nodules, increase in the size of previously detected nodules, and decrease in the size or complete resolution of nodules in response to treatment. Finally, the accuracy of this real-time assessment method was confirmed with end-point histological quantification. This technique paves the way for planning and conducting more complex experiments on lung cancer animal models, and it enables us to better understand the mechanisms of carcinogenesis and the effects of different treatment modalities while saving time and resources.

An outcomes analysis of anterior epistaxis management in the emergency department.

BackgroundMany treatment options exist for the management of anterior epistaxis. However, little is known about treatment outcomes. The objective was to identify the currently utilised methods of management and outcomes for patients with anterior epistaxis presenting to the emergency department (ED) at a Canadian tertiary care center.MethodsA retrospective review of ED visits from January 2012-May 2014 for adult patients with a diagnosis of anterior epistaxis was performed. Patient demographic data, comorbidities, and treatment methods were documented. The effectiveness of different treatment modalities was determined.ResultsThree hundred fifty-three primary anterior epistaxis cases were included. Mean patient age was 70 years and 49 % of patients were female. Comorbidities included hypertension (56 %), diabetes (19 %), CAD (28 %), and atrial fibrillation (27 %). A large proportion of the cohort (61 %) was on at least one anticoagulant or antiplatelet therapy. The most common utilised treatment modalities were silver nitrate cauterization, Merocel®, petroleum gauze packing, nasal clip and 15 % were simply observed. Initial treatment success was achieved in 74 % of cases. Of patients receiving specific treatment modalities, silver nitrate cauterization had the highest success rate at 80 %. 26 % of patients returned to the ED for recurrence of epistaxis with highest rates occurring in the nasal clip (59 %), Merocel® (26 %), and petroleum gauze packing (42 %) groups.ConclusionsThe differences in recurrence rate among the different treatment modalities observed may be due to true differences in effectiveness or differences in treatment selection by the ED physicians based on severity of epistaxis. Cauterization with silver nitrate, however, offers the added benefit of no need for follow up. Further study is needed to elucidate the most efficacious treatment modality based on epistaxis severity.

A 4-year Follow-up Evaluation Of A Pharmacist-managed Smoking Cessation Programme With Emphasis On Effectiveness Of Different Treatment Modalities

A 4-year Follow-up Evaluation Of A Pharmacist-managed Smoking Cessation Programme With Emphasis On Effectiveness Of Different Treatment Modalities