Entire Treatment Research Articles

Poor sleep quality and associated factors among adult chronic kidney disease patients.

Poor sleep quality is a common concern in chronic kidney disease (CKD) patients, which can accelerate the progression of chronic renal disease and negatively impact their health-related quality of life, potentially leading to greater morbidity and mortality rates. It can also have an effect on the immune system, cognitive function, and emotional well-being of CKD patients. Furthermore, poor sleep quality may contribute to drug noncompliance and decreased participation in the entire treatment plan. Nonetheless, no research has been undertaken in Ethiopia on the prevalence of poor sleep quality and its associated factors among CKD patients. This study aimed to assess the prevalence of poor quality of sleep and associated factors among chronic kidney disease patients at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals in 2020. A cross-sectional study design was implemented at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals between February and April 2020. The study participants were chosen through systematic random sampling techniques. The Pittsburgh Sleep Quality Index (PSQI), a validated assessment tool, was utilized to measure sleep quality. A PSQI total score > 5 was used as an indicator of poor sleep quality. Subsequently, the data obtained were entered into Epi Data version 3.0 and then transferred to STATA 14 for analysis. Both bivariable and multivariable binary logistic regression analyses were performed to recognize factors associated with poor sleep quality. In the multivariable logistic regression analysis, variables demonstrating a p-value of ≤0.05 were considered statistically associated to poor sleep quality. In this study, 424 CKD patients were included. Among screened CKD patients, 42.9% tested positive for poor sleep quality with a 95% CI (38 to 47%). Independent predictors of poor sleep quality among CKD patients were common mental disorder [AOR = 1.8, 95% CI (1.19-2.89)], anemia [AOR = 2.7, 95% CI (1.71-4.36)], declined eGFR between 60 and 89.9 [AOR = 1.6; 95% CI (2.28-5.54)], 30-59.9 [AOR = 2.6, 95% CI (1.53-4.43)], and ≤ 30 [AOR = 3.8, 95% CI (1.17-12.61)], age > 50 years [AOR = 1.7(1.11-2.69)] and duration of disease 2.9 [AOR = 2.9, 95% CI (1.77-4.90)]. In our study, almost 1 out of 2 CKD patients assessed for poor sleep quality tested positive. It was noted that poor sleep quality was more frequent among CKD patients with common mental disorders, anemia, decreased eGFR levels, individuals aged over 50 years, and those with a longer duration of the disease. Consequently, it's advised to regularly screen these CKD patients for poor sleep quality.

Lenvatinib plus Pembrolizumab Combination Therapy for Advanced or Recurrent Endometrial Cancer: A Single-Center, Retrospective Analysis.

A multi-kinase inhibitor, lenvatinib, plus an immune checkpoint inhibitor, pembrolizumab, became a viable therapeutic option for advanced or recurrent endometrial cancer in Japan by the end of 2021. The Japanese population has a relatively unique genetic background. Hence, the safety profile and effectiveness of lenvatinib plus pembrolizumab may differ between the Japanese and other populations. This single-center, retrospective study aimed to evaluate the treatment efficacy of lenvatinib plus pembrolizumab and the safety profile of the associated adverse events. The clinical records of 15 patients, who received lenvatinib plus pembrolizumab for advanced or recurrent endometrial cancer at the Tohoku University Hospital, were reviewed. Best overall response and disease control rates were 40.0% and 73.3%, respectively. Treatment was discontinued owing to disease progression and adverse events in six patients, respectively. As of the end of July 2023, treatment was ongoing in the remaining three patients. The median treatment and progression-free survival durations were 118 and 258 days, respectively. Relative dose intensity of lenvatinib was not positively associated with progression-free survival, neither during the first 4 weeks after treatment initiation nor during the entire treatment period. All patients experienced one or more adverse events, the most common of which were hypothyroidism (90%) and hypertension (83.3%). Among the 15 patients, 13 required lenvatinib dose reduction owing to adverse events. One patient developed grade 4 interstitial pneumonia requiring intensive care. Our results validate the short-term efficacy of lenvatinib plus pembrolizumab, and indicate that dose optimization of lenvatinib could be individualized without impairing efficacy.

Practical guidance for CAR T-cell therapy in adults

Chimeric antigen receptor (CAR) T-cell therapy is an innovative treatment for B-cell malignancies and multiple myeloma. CAR T-cell therapy is now approved in Japan and has become one of the essential therapeutic options for chemotherapy-resistant disease. It has many unique features that distinguish it from conventional chemotherapies, including the limitations imposed by the production of CAR-T cells from autologous T cells, and the limited availability and mandatory waiting period for treatment. Importantly, each patient has only one opportunity to receive CAR T-cell therapy. To achieve the maximum therapeutic benefit from CAR T-cell therapy, it is necessary to understand all aspects of CAR T-cell therapy, including factors that influence its efficacy. The design of the entire treatment sequence, including before and after CAR T-cell therapy, is also important to optimize clinical outcomes. In addition, since this treatment is only available at a limited number of facilities, effective coordination between local hospitals and treatment centers is also important. This educational session will focus on the practical aspects of CAR T-cell therapy in adults and will provide indispensable knowledge for providing CAR T-cell therapy to patients with B-cell lymphoma and multiple myeloma.

ChemoProtective effects of new iodine coordinated compound in benzo[a]pyrene- induced lung cancer in BALB/c mice

Iodine preparations are widely used in medicine as antiseptic agents. One of the new directions for the use of iodine is the prevention and therapy of certain tumor diseases, particularly breast cancer. The main mechanism of action is the induction of apoptosis. Iodine also has anti-inflammatory activity and affects the polarization of Th1/Th2 lymphocytes and M1/M2 macrophages. The newly developed iodine complex KC-144 includes both dextrin and polypeptides. In this case, lithium enhances the polarization of triiodide. We studied the acute toxicity and prophylactic activity on a model of benz(a)pyrene-induced (BaP) tumor in BALB/c mice. The average lethal dose (LD50) of KC-144 when administered orally was more than 2500 mg/kg, classifying KC-144 as a low-toxicity substance. Intraperitoneal administration of benz(a)pyrene at a dose of 100 mg/kg for two weeks induces tumor development in mice. Oral administration of KC-144 at doses of 2.5 and 25 mg/kg for one week and throughout the entire treatment period increases the lifespan of BaP-induced mice.

Insight into the Role of Optical Coherence Tomography in Acute Coronary Syndrome following Scrub Typhus: A Case Report

Scrub typhus, an illness stemming from the Orientia tsutsugamushi bacterium within the Rickettsiaceae family, is recognised for its febrile nature and frequently linked to vasculitis-induced complications. The challenges faced in the management of scrub typhus complicated by Acute Coronary Syndrome (ACS) and Multiple Organ Dysfunction Syndrome (MODS) is presented in this case report. Of particular significance, this report introduces a novel approach of employing Optical Coherence Tomography (OCT) to identify the underlying pathology, which guided us in making the treatment decision-a novel application of OCT in infectious disease management yet to be documented in the existing medical literature. In present case, OCT was used and the lesion was characterised to be vasculitic and not atherosclerotic, thereby changing the entire treatment course, benefiting the patient. This innovative utilisation of OCT throws light over vasculitic pathology of present case and emphasises the need for intracoronary imaging in the management of this rare complication of a fairly common tropical disease.

Combined use of 3D printing and mixed reality technology for neurosurgical training: getting ready for brain surgery.

Learning surgical skills is an essential part of neurosurgical training. Ideally, these skills are acquired to a sufficient extent in an ex vivo setting. The authors previously described an in vitro brain tumor model, consisting of a cadaveric animal brain injected with fluorescent agar-agar, for acquiring a wide range of basic neuro-oncological skills. This model focused on haptic skills such as safe tissue ablation technique and the training of fluorescence-based resection. As important didactical technologies such as mixed reality and 3D printing become more readily available, the authors developed a readily available training model that integrates the haptic aspects into a mixed reality setup. The anatomical structures of a brain tumor patient were segmented from medical imaging data to create a digital twin of the case. Bony structures were 3D printed and combined with the in vitro brain tumor model. The segmented structures were visualized in mixed reality headsets, and the congruence of the printed and the virtual objects allowed them to be spatially superimposed. In this way, users of the system were able to train on the entire treatment process from surgery planning to instrument preparation and execution of the surgery. Mixed reality visualization in the joint model facilitated model (patient) positioning as well as craniotomy and the extent of resection planning respecting case-dependent specifications. The advanced physical model allowed brain tumor surgery training including skin incision; craniotomy; dural opening; fluorescence-guided tumor resection; and dura, bone, and skin closure. Combining mixed reality visualization with the corresponding 3D printed physical hands-on model allowed advanced training of sequential brain tumor resection skills. Three-dimensional printing technology facilitates the production of a precise, reproducible, and worldwide accessible brain tumor surgery model. The described model for brain tumor resection advanced regarding important aspects of skills training for neurosurgical residents (e.g., locating the lesion, head position planning, skull trepanation, dura opening, tissue ablation techniques, fluorescence-guided resection, and closure). Mixed reality enriches the model with important structures that are difficult to model (e.g., vessels and fiber tracts) and advanced interaction concepts (e.g., craniotomy simulations). Finally, this concept demonstrates a bridging technology toward intraoperative application of mixed reality.

Application and challenge of HER2DX genomic assay in HER2+ breast cancer treatment.

HER2-positive breast cancer is highly aggressive, with a significant risk of recurrence and metastasis, leading to a poor prognosis. While most early-stage HER2-positive breast cancer patients benefit from combining trastuzumab monoclonal antibody with chemotherapy, the therapeutic response to various drug combinations varies across the HER2+ patient population. Therefore, predicting the prognosis and treatment response of HER2+ breast cancer patients to specific regimens is crucial for selecting appropriate precision individualized therapies. HER2DX is the first genomic tool designed to guide the treatment of HER2+ breast cancer patients. The three scores provided by HER2DX inform the entire treatment process, including predicting survival outcomes, recurrence, metastasis, and treatment responses like Pathological Complete Response Rate (pCR). It offers recommendations on follow-up intervals, treatment plans, and the duration of drug therapy. This review examines the literature and analyzes studies applying HER2DX to guide the comprehensive treatment and predict prognosis in HER2+ breast cancer patients, aiming to promote the widespread use of HER2DX in individualized treatment.

Характеристика и управление нежелательными реакциями у пациентов с распространенным раком эндометрия, которые получают комбинацию ленватиниб плюс пембролизумаб

Background. Lenvatinib plus pembrolizumab significantly improved efficacy compared with chemotherapy in patients with advanced endometrial cancer (aEC) regardless of microsatellite instability status or histologic subtype, who had disease progression following prior platinum-based therapy, in Study-309/KEYNOTE-775. The safety profile of the combination was generally consistent with that of each monotherapy drug and of the combination in patients with endometrial cancer and other solid tumors. Given the medical complexity of patients with aEC, this paper aims to characterize key adverse reactions (ARs) of the combination treatment and review management strategies, providing a guide for AR management to maximize anticancer benefits and minimize treatment discontinuation. Materials and methods. In Study-309/KEYNOTE-775, patients received lenvatinib (20 mg orally once daily) plus pembrolizumab (200 mg intravenously every 3 weeks) or chemotherapy (doxorubicin or paclitaxel). The incidence and median time to the first onset of ARs, dose modifications, and concomitant medications are described. Key ARs characterized include hypothyroidism, hypertension, fatigue, diarrhea, musculoskeletal disorders, nausea, decreased appetite, vomiting, stomatitis, weight decreased, proteinuria, and palmar-plantar erythrodysesthesia syndrome. Results. As expected, the most common any-grade key ARs included: hypothyroidism, hypertension, fatigue, diarrhea, and musculoskeletal disorders. Grades 3-4 key ARs with incidence ≥10% included: hypertension, fatigue, and weight decreased. Key ARs first occurred within approximately 3 months of treatment initiation. AR management strategies consistent with the prescribing information and the study protocol are discussed. Conclusion. Successful AR management strategies for lenvatinib plus pembrolizumab include education of the patient and entire treatment team, preventative measures and close monitoring, and judicious use of dose modifications and concomitant medications.

Out-of-field dosimetry using a validated PHITS model and computational phantom in clinical BNCT.

The out-of-field radiation dose for boron neutron capture therapy (BNCT), which results from both neutrons and γ-rays, has not been extensively evaluated. To safely perform BNCT, the neutron and γ-ray distributions inside the treatment room and the whole-body dose should be evaluated during commissioning. Although, certain previous studies have evaluated the whole-body dose in the clinical research phase, no institution providing BNCT covered by health insurance has yet validated the neutron distribution inside the room and the whole-body dose. To validate the Monte Carlo model of the BNCT irradiation room extended for the whole-body region and evaluate organ-at-risk (OAR) doses using the validated model with a human-body phantom. First, thermal neutron distribution inside the entire treatment room was measured by placing Au samples on the walls of the treatment room. Second, neutron and gamma-ray dose-rate distributions inside a human-body water phantom were measured. Both lying and sitting positions were considered. Bare Au, Au covered by Cd (Au+Cd), In, Al, and thermoluminescent dosimeters were arranged at 11 points corresponding to locations of the OARs inside the phantom. After the irradiation, γ-ray peaks emitted from the samples were measured by a high-purity germanium detector. The measured counts were converted to the reaction rate per unit charge of the sample. These measurements were compared with results of simulations performed with the Particle and Heavy Ion Transport code System (PHITS). A male adult mesh-type reference computational phantom was used to evaluate OAR doses in the whole-body region. The relative biological effectiveness (RBE)-weighted doses and dose-volume histograms (DVHs) for each OAR were evaluated. The median dose (D50% ) and near-maximum dose (D2% ) were evaluated for 14 OARs in a 1-h-irradiation process. The evaluated RBE-weighted doses were converted to equivalent doses in 2Gy fractions. Experimental results within 60cm from the irradiation center agreed with simulation results within the error bars except at±20, 30cm, and those over 70cm corresponded within one digit. The experimental results of reaction rates or γ-ray dose rate for lying and sitting positions agreed well with the simulation results within the error bars at 8, 4, 11, 7 and 7, 4, 7, 6, 5, 6 out of 11 points, respectively, for Au, Au+Cd, In, Al, and TLD. Among the detectors, the discrepancies in reaction rates between experiment and simulation were most common for Au+Cd, but were observed randomly for measurement points (brain, lung, etc.). The experimental results of γ-ray dose rates were systematically lower than simulation results at abdomen and waist regions for both positions. Extending the PHITS model to the whole-body region resulted in higher doses for all OARs, especially 0.13Gy-eq increase for D50% of the left salivary gland. The PHITS model for clinical BNCT for the whole-body region was validated, and the OAR doses were then evaluated. Clinicians and medical physicists should know that the out-of-field radiation increases the OAR dose in the whole-body region.

Recovery of energy and carbon fibre from wind turbine blades waste (carbon fibre/unsaturated polyester resin) using pyrolysis process and its life-cycle assessment

Recovery of carbon fibres and resin from wind turbine blade waste (WTB) composed of carbon fibres (CF)-reinforced unsaturated polyester resin (UPR) has been environmentally challenging due to its complex structure that is not biodegradable and that is rich in highly toxic styrene (main component of UPR). Within this framework, this paper aims to liberate CF and UPR from WTB using a pyrolysis process. The treatment was performed on commercial WTB (CF/UPR) up to 600 °C using a 250 g reactor. The UPR fraction was decomposed into liquid and gaseous phases, while CF remained as a residue. The composition of gaseous phase was monitored during the entire treatment using a digital gas analyser, while gas chromatography-mass spectrometry (GC-MS) was used to characterize the collected liquid phase. CF fraction was collected and exposed to additional oxidation process after treatment at 450 °C for purification propose, then it was analysed using FTIR and SEM-EDX. Finally, the life cycle assessment (LCA) of the CF/UPR pyrolysis was studied using SimaPro software and the results were compared with landfill disposal practices. The pyrolysis results manifested that 500 °C was sufficient for UPR decomposition into styrene-rich oil and gaseous products with yields of 15.23 wt% and 6.83 wt%, respectively, accompanied by 77.93 wt% solid residue including CF. The LCA results showed that pyrolysis with oxidation process has high environmental potential in WTB recycling with significant reduction in several impact categories compared to landfill. However, the pyrolysis scenario revealed several additional environmental burdens related to ecosystems, acidification, Ozone formation, and fine particulate matter formation that must be overcome before upscaling.

Evaluation of a microencapsulated form of zinc oxide on weanling pig growth performance, fecal zinc excretion, and small intestinal morphology.

A total of 300 pigs (DNA 200 × 400; initially 6.0 ± 0.08kg body weight [BW]) were used in a 42-d study to evaluate a microencapsulated form of zinc oxide. At weaning, pigs were randomly allocated to pens, and pens were randomly assigned to dietary treatments with 5 pigs per pen and 12 pens per treatment. Dietary treatments were 1) negative control (CON; standard nursery diet containing 110ppm Zn in the form of zinc sulfate from trace mineral premix); 2) control diet with 400ppm added Zn from ZnO included in phases 1 and 2 (Low-ZnO); 3) control diet with 3,000ppm added Zn from ZnO included in phase 1 and 2,000ppm added Zn from ZnO included in phase 2 (High-ZnO); 4) control diet with 400ppm added Zn from microencapsulated ZnO included in phases 1 and 2 (Low-MZnO; Vetagro S.p.A., Reggio Emilia, Italy); 5) control diet with 3,000ppm added Zn from microencapsulated ZnO in phase 1 and 2,000ppm added Zn from microencapsulated ZnO in phase 2 (high-MZnO; Vetagro S.p.A., Reggio Emilia, Italy). On days 10 and 28, fecal samples from 2 pigs per pen were collected for fecal Zn concentrations, and on day 28, 30 pigs (n = 6) were euthanized, and small intestinal tissues were collected to evaluate morphology. For the entire treatment period (days 0 to 28) there was no evidence of differences in average daily gain (ADG), average daily feed intake (ADFI), or G:F (P > 0.05). During the common phase 3 (days 28 to 42) pigs fed the negative control, High-MZnO, or Low-MZnO had improved (P < 0.0001) ADG and ADFI compared to pigs fed High- or Low-ZnO. For the entire experiment (days 0 to 42), pigs fed Low-ZnO or High-ZnO had reduced (P < 0.0001) ADG compared to those fed the negative control. A significant treatment × day interaction (P = 0.04) was observed for fecal Zn concentrations, where the level of Zn excreted in the feces was dependent on the sampling day in pigs fed a low level of ZnO or low level of microencapsulated ZnO. There was no evidence (P > 0.05) that small intestinal morphology differed significantly between treatments. In summary, feeding a microencapsulated form of ZnO did not alter piglet growth performance during the treatment period. Pigs fed a low level of ZnO or microencapsulated ZnO had reduced fecal Zn excretion by the end of the feeding period, but no significant impacts were observed on piglet small intestinal morphology.

Revolutionizing Patient Monitoring in Age-Related Macular Degeneration: A Comparative Study on the Necessity and Efficiency of the AMD VIEWER.

(1) Background: Age-related Macular Degeneration (AMD) is a critical condition leading to blindness, necessitating lifelong clinic visits for management, albeit with existing challenges in monitoring its long-term progression. This study introduced and assessed an innovative tool, the AMD long-term Information Viewer (AMD VIEWER), designed to offer a comprehensive display of crucial medical data-including visual acuity, central retinal thickness, macular volume, vitreous injection treatment history, and Optical Coherent Tomography (OCT) images-across an individual eye's entire treatment course. (2) Methods: By analyzing visit frequencies of patients with a history of invasive AMD treatment, a comparative examination between a Dropout group and an Active group underscored the clinical importance of regular visits, particularly highlighting better treatment outcomes and maintained visual acuity in the Active group. (3) Results: The efficiency of AMD VIEWER was proven by comparing it to manual data input by optometrists, showing significantly faster data display with no errors, unlike the time-consuming and error-prone manual entries. Furthermore, an elicited Net Promoter Score (NPS) of 70 from 10 ophthalmologists strongly endorsed AMD VIEWER's practical utility. (4) Conclusions: This study underscores the importance of regular clinic visits for AMD patients. It suggests the AMD VIEWER as an effective tool for improving treatment data management and display.

Congruent vs. incongruent tasks in interdisciplinary stroke rehabilitation: a single-case report

Purpose Stroke survivors may experience challenges in multiple domains (e.g., speech-language, dexterity, mobility) and pursue services from multiple professionals. Clinicians typically provide rehabilitation services in back-to-back sessions (multidisciplinary). Alternatively, two or more clinicians can co-treat a stroke survivor in one session (interdisciplinary). This pilot project examined task congruency in interdisciplinary stroke care. Method A stroke survivor chronically challenged by non-fluent aphasia and right hemiparesis completed spoken-naming and upper-limb tasks simultaneously. The concurrent tasks were presented in two conditions: congruent (i.e., naming a pictured item while tracing the first letter of the name) and incongruent (i.e., naming a pictured item while tracing a non-symbolic shape). The sequence of the two conditions was: baseline probes, congruent practice (eight weeks), no practice (eight weeks), incongruent practice (eight weeks), and no practice (eight weeks). The entire treatment program was implemented as independent home practice utilizing a computer. Results The participant made significant improvements in naming and clinically meaningful gains in arm movements during the congruent condition, but not during the incongruent condition. Conclusions Data from this study suggest a potentially positive effect of simultaneous speech-language and upper-limb tasks. More research is warranted to further examine the role of task congruency in interdisciplinary stroke rehabilitation.

Subconjunctival autologous muscle‐derived mesenchymal stem cell therapy: A novel, minimally invasive approach for treating equine immune‐mediated keratitis

AbstractObjectiveTo establish the safety of subconjunctival injections of autologous muscle‐derived mesenchymal stem cells (mdMSCs) in healthy horses and to evaluate their effect in four horses (six eyes) with severe chronic equine immune‐mediated keratitis (IMMK) that was unresponsive to medical treatments.MethodsMdMSCs were cultured from minimally invasive muscle biopsies. In the safety group, four healthy horses received two subconjunctival injections of 2.5 and 5 million cells, respectively, at 1‐month interval, to the same eye. Ocular side effects were monitored for 1 month following each injection. In the treatment group, six eyes received four to seven subconjunctival mdMSCs injections (2.5 or 5 million cells per injection) every 4 weeks, approximatively. Medical treatment was discontinued 1 week before and throughout the entire treatment period. A scoring system was used to assess the evolution of the ocular lesions.ResultsIn the safety group, all horses exhibited mild to moderate chemosis and conjunctival hyperemia at the injection site, lasting 24–48 h. In the treatment group, all eyes initially responded positively to therapy, with a reduction in lesion scores observed after the first injection. Four eyes achieved control of the lesions with repeated injections during the 9.2 months of follow‐up.ConclusionThe first subconjunctival injection of mdMSCs resulted in improvement of the ocular lesions. Repeated injections were found to be safe, minimally invasive and showed promise in managing refractory cases of equine IMMK. Further studies are warranted to demonstrate the long‐term benefits of these injections and to optimize the therapeutic protocol.

“Managing Class II Div I Malocclusion with Clear Path Aligners Utilizing an Extraction-Based Treatment Approach: A Case Report”

This case report is based on the clear aligner treatment of an adult patient presented with class II div I malocclusion. The case was treated with the extraction of upper first premolars and interproximal reduction in the lower arch. Total 35 sets of upper aligners and 25 sets of lower aligners were delivered with the wear time of 22 hours per day for 10 days. The entire treatment course spanned a period of 14 months. Thus, the case study underscores the reliability of orthodontic treatment with clear aligners for addressing class II malocclusion. The discreet nature of these aligners not only enhances periodontal health but also increases patient acceptance. As a result, they are more likely to embrace and adhere to the treatment, fostering better overall outcomes.

A PHARMACOECONOMIC EVALUATION OF DRUGS IN PATIENTS OF PAINFUL DIABETIC NEUROPATHY

Aims and objectives: To study the effect of methylcobalamin, the combination of methylcobalamin with pregabalin, and methylcobalamin with duloxetine in patients with painful diabetic neuropathy after comparing the safety, tolerability, and economic implications of all three study groups. Methods: The present study was a prospective, open-labeled, interventional, randomized, and parallel-group study conducted on 100 patients of painful diabetic nephropathy from the outpatient department of the hospital who were recruited after obtaining informed consent. The permission for the study was taken from the Institutional Ethical Committee. The patients were randomized into three study groups: A, B, and C, on methylcobalamin, methylcobalamin, pregabalin, methylcobalamin, and duloxetine. Results: The mean value of the price of each tablet from all the brands of the respective drugs and finally calculating the cost for the whole 3 months which comes out to be Rs. 797.4 for group A, Rs. 1940.4 for group B, and Rs. 1163.7 for group C. The cost of the entire treatment and the effect produced in terms of the difference in the visual analog scale score from day 1 to the end of week 12 which are 0.58 for group A, 3.82 for group b, and 4.17 for group C. Conclusion: The primary purpose of the pharmacoeconomic evaluation is not to directly alter the therapeutic decisions of the physicians but to help the physicians, pharmacists, and policymakers to make informed decisions about whether the cost and extra benefits of the new drug are meaningful within the given budget.

A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms

BackgroundCervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms. MethodsA 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness. ResultsThe ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL. ConclusionsThe available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly. Level of evidenceII, prospective cohort study.

CONTROL SYSTEM FOR WASTEWATER TREATMENT PROCESS

The main direction of the automation of the wastewater treatment process are considered, the main blocks of mechanical and biological treatment of wastewater are shown, the entire technological treatment process and the general treatment process is described, including the reusing of disinfected water after the chlorinator. The issues of energy saving in the aeration station were investigated, the main concepts in this field were analyzed, and a structural scheme was proposed reflecting the issues to be solved and applied for the purpose of energy management (energy management) in the station. It was noted that general energy saving measures include equipping pump motors with frequency converters and soft start devices, using alternative and renewable energy, using the energy of liquid flows, connecting and opening electrical devices and apparatus with a program and a light sensor, sewage entering the station It can include the production of electricity using the temperature and output gases or the heating of auxiliary buildings and the production of energy due to the processing (incineration) of sludge and garbage obtained in the cleaning process. Considering of the complete structure of the management system of the wastewater treatment process the control algorithm was proposed. In addition to the energy management subsystem, the system includes local management-adjustment tools and subsystems necessary to manage the cleaning process itself. Keywords: wastewater, control system, energy management subsystem, control algorithm, fuzzy control.

Comparative Evaluation of Various Lens and Ring Flash Combination for Intraoral Photography.

Extraoral and intraoral dental photographs serve as preoperative records and document the entire treatment. Correctly composed orthodontic photographs are crucial for remote diagnosis and may serve as a bulwark against medicolegal challenges. In this prospective study, intraoral frontal photographs of patients with ideal occlusion were taken using two types of lenses (EF-S 18-55 mm f/3.5-5.6 IS STM lens (Canon, Tokyo, JP), SP 90 mm F/2.8 MACRO VC lens (Model F017 Tamron, NY, USA)) and two different ring flash systems (Meike FC-100 Macro Ring LED Light (Meike, China), Macro Ring flash Lite YN-14EX (Yongnuo digital, China)). The combination of lens and flash used was grouped into four groups. Twenty-eight intraoral photographs of patients were taken. An image quality assessment survey was distributed among two groups - 50 orthodontists and 50 other dental specialists. The participants were asked to assess all the intraoral images and subjectively score them on a scale of one to ten, with one being very poor and ten being excellent, considering the sharpness, color, brightness, contrast, and overall quality of the image. The general dentists rated the images taken with a 90-mm macro lens and ring flash as the best quality photographs. Images obtained using an 18-55 mm lens and ring LED received significantly lesser scores and were graded good by dentists. This combination of lens and flash may prove a valuable investment in the long-term aiding in excellent dental images for diagnosis and treatment monitoring.

The dual sugar test (lactulose plus mannitol) is an unreliable indicator of feed withdrawal-associated changes in intestinal permeability in broiler chickens

Despite its importance in poultry research, there is lack of standardized and practical techniques to measure intestinal permeability in a noninvasive manner. Therefore, this research sought to standardize a procedure using lactulose (Lac) and mannitol (Man) to measure intestinal barrier function in broilers. Twenty-one-day-old male and female Ross 308 birds were orally gavaged (either 2 mL/kg BW or fixed 3 mL per bird) with a solution containing 5 to 25 g Lac and 1 to 5 g Man dissolved in pure water to reach 100 mL of final solution. Feed withdrawal (FW; 2-24-h duration) prior to dosing with Lac and Man (LacMan) was mainly used to induce graded intestinal permeability. Blood samples were collected at 60-, 90-, or 120-min after LacMan dosing using serum or plasma (K2EDTA and/or Na-Heparin) blood tubes. Lac and Man concentrations were quantified by HPLC. Plasma samples collected 90-min after LacMan dosing elicited the least variable response (22.4% vs. 22.8% or 23.4% CV when compared with 60- and 120-min sampling time-points, respectively), and both markers were detectable after administering a solution containing the lowest concentration of Lac and Man. However, analytical problems arose when using Na-Heparin anticoagulant as high glucose levels interfered with Lac quantification. Upon improving the chromatographic technique, it became evident that a 24-h FW increased (P < 0.01) Lac concentrations. In the last trial, a more severe glucose interference was observed, resulting in no Lac detection within an entire treatment group. Twelve hours of FW increased (P < 0.01) Man concentration in the plasma of birds receiving the solution containing 3 g Man, but had no effect on the birds receiving the solution containing 5 g Man. A 24-h FW did not affect the Man concentrations in birds receiving the solution containing either 3 or 5 g Man. With inconsistency of Lac detection throughout our trials, it was concluded that the combination of Lac and Man is an unreliable marker to predict intestinal barrier function in broilers.