Intervention In Treatment Of Patients Research Articles

Long-Term, Sustained, Lifestyle-Induced Weight Loss in Severe Obesity: the Get-Real Program

To study the long-term effectiveness of a patient-centered, multidisciplinary lifestyle intervention treatment in patients medically eligible for bariatric surgery. Using a case-control study design, we compared treatment results for 98 adults (mean body mass index [BMI], 44.2 kg/m(2)) with the outcomes of 148 controls (mean BMI, 43.0 kg/m(2)) receiving standard care. The approach included a phased triage for inclusion, followed by 12 lifestyle intervention group sessions alternating with individual visits for behavior, diet, and exercise instructions. At 2 years, weight loss averaged 15.3 ± 1.4 kg (P<.0010) (12 ± 1% of initial body weight [IBW], P<.001; 21 ± 2% of excess body weight [EBW], P<.001) in an intention-to-treat (ITT) analysis; in completers, weight loss was 18.8 ± 1.5 kg (P<.001) (15 ± 1% IBW, P<.001; 26 ± 3% EBW, P<.001). A total of 42 patients lost ≥10% IBW. Controls remained weight stable (P = .35); 3% lost ≥10% IBW. Patients achieving weight loss that would be considered satisfactory for bariatric surgery included 20% who achieved ≥35% EBW loss, 29% who achieved a BMI <35 kg/m(2) (if starting BMI <50 kg/m(2)) or BMI <40 kg/m(2) (if starting BMI ≥50 kg/m(2)), and 37% who achieved EBW loss ≤50%. These values for completers were 31, 39, and 48%, respectively. In the 55 patients starting the program ≥4 years ago, weight loss maintenance of 12 ± 1% IBW (ITT, 16 ± 1% in completers) was observed. Substantial nonsurgical weight loss, maintained at 2 to 4 years, is achievable in severely obese patients using comprehensive lifestyle approaches; the efficacy/safety trade-off in obesity treatment is an important consideration in interpreting these results.

Using the Seldinger Technique Cerebral Angiography (DSA) Line of Intravascular Interventional Treatment for Patients with Care

In the event of cerebrovascular disease, simple medical treatment is very difficult to have expected effect. Interventional therapy is a new type of diagnosis and treatment in cerebrovascular technology, with advantage of less trauma, safer, more curative effect, quicker recovery, and easier to accept. Neurology department in the hospital i belonging to had performed the Seldinger technique cerebral angiography (DSA) for 68 patients with intravascular interventional therapy from January 2013 to January 2014. Through the establishment of special preoperative and postoperative nursing dedicative team, implement the system of process type intensive care good results have been achieved.

Effectiveness of Cardiac Rehabilitation for Patients With Cardiac Disease Undergoing Coronary Artery Bypass Graft (CABG)

Background: Cardiac rehabilitation (CR) can reduce risk factors and mortality rate and improve physical functions. Coronary artery bypass grafting (CABG) is commonly performed for patients with coronary disease. Objectives: The purpose of this study was to investigate the effect of CR program on quality of life in patients with cardiac disease who had undergone CABG. Patients and Methods: Twenty patients with cardiac disease who had undergone CABG participated in this study. The coronary revascularization outcome questionnaire (CROQ) was used to evaluate health outcomes and quality of life after CR. The patients filled the questionnaire before and after 20 sessions of CR. Results: CR improved the overall quality of life in patients with cardiac disease who had undergone CABG (P < 0.05). The results also demonstrated a significant improvement in subscores of symptoms, psychosocial and cognition functions after CR. However, no significant difference was found in subscore of physical function in patients who had undergone CABG. Conclusions: CR can improve the quality of life in patients with diabetes and cardiac disease who had undergone CABG and can be considered as a treatment intervention for patients with cardiac disease.

Effect of multimodality treatment on overall survival for patients with metastatic or recurrent HPV-positive head and neck squamous cell carcinoma

The optimal treatment for patients with recurrent human papillomavirus (HPV)-positive head and neck cancer is poorly understood. We investigated treatments and outcomes in patients with recurrent head and neck cancer. Treatments included salvage neck surgery, metastasectomy, hypofractionated reirradiation, chemoembolization, and chemotherapy. Treatment outcomes were compared based on HPV status. A total of 37 patients were identified (12 HPV positive and 25 HPV negative). Demographics were similar. Overall, there was a trend toward a higher number of total treatment interventions in patients with HPV-positive disease (4.5 vs 2.6), but this was statistically insignificant (p=.066). After a mean follow-up of 21 months, median survival in HPV-negative patients was 10.6 months, whereas the median survival had not been reached for HPV-positive patients. Of the 12 HPV-positive patients, 7 were still alive (58%) after a mean follow-up period of 33 months. Multimodality aggressive therapy may improve overall survival in patients with recurrent HPV-positive disease. Further prospective research is warranted.

Effect of interventional treatment for patients with coronary heart disease on brain natriuretic peptide and hsCRP levels

Objective To investigate the effect of interventional treatment in coronary heart disease (CHD) in elderly patients with brain natriuretic peptide and high-sensitivity C-reactive protein (hsCRP) levels.Methods 130 elderly patients undergoing coronary angiography interventional treatment were selected for the observation group,30 cases with normal coronary arteries angiography were chosen as the control group.In 46 cases of acute myocardial infarction(AMI) group,34 cases of unstable angina pectoris(UAP) group and 50 patients with stable angina pectoris (SAP) group and 30 cases coronary angiography normal control group(NOR),the hs-CRP and plasma brain natriuretic peptide(BNP) differences were determined and compared.Results CHD (AMI group,UAP group and SAP group) in patients with BNP levels were (548.6 ± 200.4) mg/L,(521.0 ± 198.7) mg/L and (175.8 ± 119.4) mg/L,which were significantly higher (59.3 ± 45.7) mg/L in the control group,hsCRP levels only in patients with acute myocardial infarction and unstable angina was significantly increased,the difference was statistically significant (t =13.74,10.65,all P ＜ 0.05).3d after PCI and three months prior CHD hsCRP increased to (45.8 ± 15.3)ng/L,and then decreased to (8.6 ± 4.4) ng/L,significantly different (t =10.76,14.54,all P ＜ 0.05) ; while BNP levels have been falling,first down (247.4 ± 70.1)mg/L,3 months after the falls (69.8 ± 20.0)mg/L,the difference was significant(t =11.47,19.64,all P＜0.05).Conclusion The levels of brain natriuretic peptide,hsCRP are reflections of coronary stenting in patients with coronary heart disease early postoperative inflammatory reaction and evaluate a sensitive indicator of disease,which may play an role in stent restenosis occurs. Key words: Coronary heart disease; Brain natriuretic peptide; C-reactive protein; intervention; Coronary angiography

Interventional treatment of mesenteric venous occlusion.

SummaryBackgroundMesenteric venous thrombus may be an incidental finding during imaging studies and asymptomatic patients are treated conservatively or with anticoagulant therapy only. Patients with symptomatic acute thrombosis causing bowel ischemia require urgent treatment, which frequently includes extensive surgery. Interventional treatment may be an alternative. Purpose: To present results of interventional treatment in patients with symptomatic occlusion of the mesenteric veins.Material/MethodsEight patients, four men and four women aged 24–74 years (mean 53 years) were treated due to symptomatic portomesenteric venous occlusion of thrombotic origin. Transhepatic (n=5), trans-splenic (n=2), and transjugular (n=4) accesses were used. Patients were treated with mechanical thrombus fragmentation (n=4), pharmacological thrombolysis (n=3) and stent placement (n=8). Additional transjugular intrahepatic portosystemic shunt (TIPS) was created to facilitate the outflow from the treated veins (n=4).ResultsThe majority of the patients required combination of different treatment methods. Resolution of symptoms with initial clinical success was achieved in seven of the eight patients, and one patient died the day after the procedure due to sepsis. Two other patients had procedure-related complications; one of them required embolization. Two patients had documented long-term clinical success with patent stents and no symptoms at one year following intervention.ConclusionsEndovascular treatment of portomesenteric occlusion in patients with acute symptomatology showed good short-term clinical success rate.

Characteristics, symptoms and treatment interventions for patients at a pain clinic – a prospective study with a three months follow up

Characteristics, symptoms and treatment interventions for patients at a pain clinic – a prospective study with a three months follow up

Efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for a randomized controlled trial

BackgroundDespite an extensive literature on treatment interventions for patients with knee osteoarthritis, studies comparing the efficacy of different exercise interventions and living the life as usual on quality of life, cartilage quality and cost-effectiveness are lacking. The aim of the present study is to compare the efficacy of two different exercise programs compared to a control group in individuals with established radiographic and symptomatic knee osteoarthritis on self-reported knee-related quality of life, knee pain, physical function, and cartilage quality.Methods/DesignA three-armed randomized controlled trial involving two exercise interventions and a control group of individuals doing as they usually do is described. The patients will have mild to moderate radiographic osteoarthritis according to the Kellgren and Lawrence classification (grade 2–3), and fulfill the American College of Rheumatology clinical criteria, be aged between 45 and 65 years, and have no other serious physical or mental illnesses. The patients will be randomly allocated to a strength exercise group; a cycling group, or a control group. The primary outcome is the Knee injury and Osteoarthritis Outcome Score knee-related quality of life subscale. Secondary outcomes include all five Knee Injury and Osteoarthritis Outcome Score subscales, morphological evaluation of cartilage including focal thickness, subchondral bone marrow edema, proteoglycan content and collagen degradation (measured using magnetic resonance imaging clinical sequences, T2 mapping and T1ρ), specific serum biomarkers, isokinetic muscle strength, maximal oxygen uptake, quality of life (EuroQol 5D), and self-efficacy (Arthritis Self-Efficacy Scale). A sample size calculation on the primary outcome showed that 207 individuals, 69 in each group, is needed to detect a clinically relevant difference of 10 points with 80% power and a significance level of 5%. Assessments will be conducted at baseline, 14 weeks, 1 year and 2 years post-randomization. The interventions will be a 14 weeks exercise program.DiscussionAlthough exercise therapy has been found to be effective in knee osteoarthritis, the knowledge of the underlying mechanisms for why exercise works is lacking. This study will contribute with knowledge on the efficacy of strength exercise versus cycling on patient-reported outcomes, cartilage quality and cost-effectiveness.Trial registrationClinicaltrial.gov Identifier: NCT01682980.

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Major depressive disorder (MDD) is a chronic, recurrent mental disease that causes serious disability. Because currently available antidepressants have limited efficacy with respect to response and remission in patients with MDD, clinicians must choose the best available treatment interventions for patients who do not respond to initial antidepressant treatment. The existing literature demonstrates that augmentation with atypical antipsychotics (AAs) shows higher response and remission rates compared with antidepressant monotherapy, but is associated with more withdrawals due to adverse events. In this paper, specific clinical issues in the use of AA augmentation for patients with MDD are briefly discussed. Given the limited information and clinical knowledge on the proper and effective use of AAs for MDD, future research should focus on practical clinical issues that can be commonly seen in routine practice but have not been addressed yet. This is because the use of AAs is likely to expand as there is good evidence for their effectiveness and tolerability as augmentation therapy for patients with MDD.

Role of endothelial dysfunction and metabolic syndrome in interventional treatment complications development in patients with coronary heart disease

Aim. To assess the influence of endothelial dysfunction and metabolic syndrome on interventional treatment coronary complications development in patients with coronary heart disease. Methods. 57 patients with coronary heart disease and concomitant metabolic syndrome (the main group) and 64 patients with coronary heart disease alone (the comparison group) were included in the study. Control group for endothelial function parameters included 33 healthy blood donors. Endothelial function was assessed by plasma and erythrocyte nitrate level, plasma L-arginine level and desquamated endothelial cell blood count before the interventional treatment and after its completion. Results. Initial signs of endothelial dysfunction were observed in both groups of patients compared to the controls. Desquamated endothelial cell blood count was significantly higher in patients with metabolic syndrome than in the comparison group. Only the desquamated endothelial cell blood count increased significantly after the interventional treatment, the difference was more pronounced (р 0.05) in patients with metabolic syndrome. Complications of interventional treatment in patients with and without symptoms of metabolic syndrome were observed in 29.8 and 14.1% respectively (р 0.05). The number of coronary artery restenoses was significantly higher in the main group than in the comparison group (12.2 and 3.1% respectively). Conclusion. Initially endothelial dysfunction was more pronounced in patients with metabolic syndrome. A significant increase of endothelial dysfunction was observed in patients of the main group after the interventional treatment. The number of interventional treatment complications and coronary arteries restenoses was significantly higher in patients with coronary heart disease and concomitant metabolic syndrome.

Abstract 9955: Suboptimal Diagnosis and Interventional Treatment of Patients with Bundle Branch Block and Acute Myocardial Infarction

Several studies have shown the benefit of rapid revascularization in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). It is a major challenge to determine the age of the bundle branch block (BBB) and triage accordingly in the acute setting. Methods Prehospital ECGs, final diagnosis and mortality were assessed in 4905 consecutive patients with suspected AMI. BBB was defined as QRS duration &gt;120 ms in the absence of pace-rhythm, AV-block or ventricular rhythm. Mortality and angiography data were obtained from the Danish Cause of Death Registry and the Western Denmark Heart Registry. Final diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into 4 groups +/-AMI and +/- BBB. Mortality was evaluated by Kaplan-Meier plots using Log rank statistics. Results AMI was diagnosed in 954 patients, of whom 118 had BBBMI. In the 3951 patients without AMI, 436 had BBB. Coronary angiography (CAG) was performed in significantly fewer patients with BBBMI compared to patients with AMI without BBB (41% vs. 68%, p&lt;0.001). In patients undergoing CAG, revascularization was more frequent in AMI patients without BBB (59% vs. 79%, p=0.002). BBBMI was categorized as new-onset in 43 patients. Significantly more patients with new-onset BBB underwent CAG compared to patients with established BBB (67% vs. 26%, p&lt;0.001). Among those undergoing CAG, there was no difference frequency of revascularization between the groups (59% vs. 58%, p=0.99). Among patients with an adjudicated diagnosis of new-onset BBBMI 2/43=5% were triaged for acute angioplasty. Patients with BBBMI had the highest mortality of all groups (Log-rank p&lt;0.001) (Figure). Conclusions: Patients with new-onset BBBMI seem to be difficult to diagnose based on ECG and symptoms, leading to low rates of invasive procedures despite high mortality. To improve outcome we recommend a more aggressive approach to diagnosing and triaging patients with BBB and chest pain.

Database of movement control in the cervical spine. Reference normal of 182 asymptomatic persons

In this study, the first normative database of movement control in the cervical spine has been established. For this purpose the Fly Test was used, which is a reliable and valid clinical test capable of detecting deficient movement control of the cervical spine in patients with neck pain and its associated disorders. One hundred and eighty-two asymptomatic persons, eighty-three men and ninety-nine women, aged 16–74 years, divided into six age groups, were recruited. The Fly Test, using a 3-space Fastrak device, recorded the accuracy of cervical spine movements when tracking three incrementally difficult movement patterns. Amplitude accuracy (AA), directional accuracy (DA), and jerk index (JI) were compared across patterns and age groups. A multivariate analysis of variance revealed a significant effect for age (p < 0.001) but not gender (p > 0.05). Lower accuracy for AA and DA in all three movement patterns was observed in the groups of subjects aged 55–64 and 65–74 years, and also for JI in the easy and medium patterns. Knowledge of normative values for the Fly Test is important and useful in identifying impaired movement control and monitoring the effectiveness of treatment interventions in patients with neck pain of traumatic and non-traumatic origin.

A new 'package of care' strategy for effective gout management

Gout is often poorly managed, with low rates of successful long-term urate lowering. A new 'package of care' intervention for treatment of patients with gout now offers ways to improve outcomes. The intervention, involving both a rheumatologist and gout nurse specialist, provides a framework for best practice in gout management.

Impact of Posttransplant Portosystemic Shunts on Liver Transplantation

Posttransplant portosystemic shunts may result in severe fatty changes, portal vein complications, or graft liver failure because they reduce the effectiveness of portal perfusion through a portal steal phenomenon. However, the indications and timing of surgical and interventional treatments for posttransplant portosystemic shunts are still a matter of debate. We performed a retrospective investigation of the present state of long-term outpatients with posttransplant portosystemic shunts. This study comprised 150 outpatients who underwent liver transplantation between October 1988 and August 2006 in our department and other facilities. The diagnosis was based on the presence of any portosystemic shunts with the diameter of more than 5 mm indicated by computed tomography. A total of 16 patients (16/150, 10.7 %) were diagnosed as having posttransplant portosystemic shunt. Among them, eight patients (8/16, 50.0 %) developed portal vein complications, and 1 (1/16, 6.3 %) developed graft liver failure. The persistence of posttransplant portosystemic shunts results in portal vein complications or graft liver failure. Therefore, surgical and interventional treatment for patients with posttransplant portosystemic shunts should be performed based on the clinical and radiologic findings.

Abstract 3196: In vivo drug sensitivity testing of CTCs isolated using the FMSA device

Abstract BACKGROUND: Cells disseminated from primary epithelial tumors into peripheral blood, called circulating tumor cells (CTCs), can be monitored to assess metastases and to provide a surrogate marker of treatment response; indeed, the enumeration of fixed CTCs with the Johnson and Johnson Veridex CellSearch System is FDA-approved for assessment of patient prognosis in metastatic breast, prostate, and colorectal cancer. The opportunity to isolate viable CTCs using the Flexible Micro Spring Array (FMSA) device – a novel microfluidic device that enriches CTCs by two physical parameters: size and flexibility – offers the possibility of testing cancer treatments in real time and rapidly providing information back to clinicians regarding the best course of treatment. OBJECTIVES: In this study, we evaluated the possibility of isolating viable CTCs from human blood using the FMSA device, growing these cells in a mouse xenograft model, and determining successful treatments for metastatic disease. METHODS: GFP-labeled HCT-116 cells were spiked into samples of blood from healthy donors to mimic the blood of patients with metastatic disease. This spiked blood was filtered using the FMSA device, and the recovered cells were implanted into the flanks of immunodeficient mice for study. A series of in vivo experiments were carried out to investigate the effect of chemotherapy on the resulting tumors. These tumors were molecularly characterized, compared to tumors derived from non-filtered cells, and analyzed for potential differences resulting from FMSA enrichment. Studies are ongoing to further investigate the use of this model and approach to culture CTCs from patients. RESULTS &amp; CONCLUSIONS: Cancer cells isolated from blood using the FMSA can proliferate when implanted subcutaneously into the flanks of immunodeficient mice – developing into tumors within two weeks. Although they grow at rates that depend on the number of cancer cells found in each mL of blood, these tumors provide a means for testing the effects of chemotherapy on CTCs in vivo. Using this model, treatments targeted towards CTCs could be assessed and provide real-time information to clinicians regarding treatment interventions for patients with metastatic cancer and detectable CTCs. It may also be possible to use this model as the primary mode for CTC culture as the in vivo environment may provide soluble factors, cell-to-cell interactions, and physical parameters that are not easily mimicked by in vitro culture. The approach has potential to help with efforts to develop personalized therapy options for patients with advanced cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3196. doi:1538-7445.AM2012-3196

Long-Term Vagus Nerve Stimulation for Severe Refractory Depression: A Case Study With a Six-Year Follow-Up

Long-Term Vagus Nerve Stimulation for Severe Refractory Depression: A Case Study With a Six-Year Follow-Up

Rationale and design of the EXAMINATION trial: a randomised comparison between everolimus-eluting stents and cobalt-chromium bare-metal stents in ST-elevation myocardial infarction

To assess the performance of the everolimus-eluting stent (EES) versus cobalt chromium bare-metal stent (BMS) in the setting of primary percutaneous coronary intervention for treatment of patients presenting with ST-segment elevation myocardial infarction (STEMI). The implantation of a drug-eluting stent in the setting of an acute myocardial infarction is still controversial. In several registries this clinical scenario has been associated with the development of stent thrombosis. The EES has demonstrated to reduce the stent thrombosis rate as compared to paclitaxel-eluting stent in randomised controlled trials, mainly performed in patients in stable clinical conditions. There are however few data regarding the effectiveness of EES in the context of STEMI. This is an investigator-driven, prospective, multicentre, multinational, randomised, single blind, two-arm, controlled trial (ClinicalTrials.gov number: NCT00828087). This trial, with an all comer design, randomises approximately 1,500 patients 1:1 to EES or BMS. Overall, any patient presenting with STEMI up to 48 hours who requires emergent percutaneous coronary intervention can be included. The primary endpoint is the patient-oriented combined endpoint of all-cause death, any myocardial infarction and any revascularisation at 1-year according to the Academic Research Consortium. Clinical follow-up will be scheduled at 30 days, six months, one year and yearly up to five years. No angiographic follow-up is mandated per protocol. This trial with broad inclusion and few exclusion criteria will shed light on the performance of the second generation EES in the complex scenario of STEMI.

Clinical analysis on interventional treatmen for patients with ostium secundum defect

ObjectiveTo evaluate the clinical efficacy of interventional therapy for patients with ostium secundum atrial septal defect (ASD).MethodsOne hundred and fifty patients (male-90, female-60), age at 2–71 (12±5) years old. Diagnosis...

Clinical evaluation of intervention in patients of secundum atrial septal defect with atrial septal aneurysm

ObjectiveTo observe the feasibility, safety and efficacy of interventional treatment in patients of secundum atrial septal defect (ASD) with atrial septal aneurysm (ASA).Methods189 patients of ASD with ASA (82 males...

Catheter Interventions for Kawasaki Disease: Current Concepts and Future Directions

During the past 15 years, clinical experience with catheter interventional treatment in patients with Kawasaki disease, including balloon angioplasty, stent implantation, rotational ablation, and transluminal coronary revascularization, has been gradually increasing. Because the coronary artery lesions in Kawasaki disease involve severe calcifications, the indications or catheter intervention techniques have not been established for adult patients with Kawasaki disease. Satisfactory acute results for coronary balloon angioplasty have been obtained in patients with a relatively short interval from the onset of disease, especially within 6 years; however, the incidence of restenosis after angioplasty is still high. Rotational ablation may be the most appropriate catheter intervention technique for patients with Kawasaki disease. The advantage of rotational ablation is the high success rate, even in patients with calcified coronary artery stenosis. Stent implantation requires larger arterial access and is not possible in younger children. Care should be paid to the detection of newly-formed aneurysms, as the formation of new aneurysms is associated with the use of additional balloon angioplasty using high pressure balloon inflation. Anticoagulation or anti-platelet regimens are essential for long-term management. Coronary intervention in Kawasaki disease requires special techniques and knowledge of cardiovascular involvement. The procedure should be managed under the close collaboration between pediatric cardiologists and coronary interventional cardiologists.