Key Factor In Treatment Research Articles

Promoting •OH-dominant Fenton-like process over peracetic acid activation by ultrafine FeOx nanoclusters anchored carbonaceous nanosheets

Peracetic acid (PAA) has recently been considered a promising oxidant candidate for heterogeneous Fenton-like reactions; however, the main generation and contribution of organic radicals (R-O•) with unsatisfactory oxidation potential compromises wastewater decontamination efficiency. In this study, we demonstrate the rational design and synthesis of ultrafine FeOx nanocluster-anchored carbonaceous nanosheets (UFe-CN) for altering the PAA activation pathway from R-O• to •OH dominant process via in situ framework collapse carbonization of MIL-53(Fe). The constructed UFe-CN/PAA system effectively accelerated refractory micropollutant (e.g., p-nitrophenol (4-NP)) decomposition by the enhanced •OH formation (up to 65.24 µmol L−1) under a wide pH range (3.0–9.0), outperforming the benchmark iron-based catalyst counterparts by 4.2–10.8 times. This outstanding Fenton-like catalytic activity of UFe-CN is primarily attributed to the significant improvement in electron mitigation, ca. 49 times higher than that of its MIL-53(Fe) counterpart, for interface catalysis reactions triggered by iron species cycling. Furthermore, to facilitate adaptive engineering, the organic pollutant removal efficiency could be easily tuned by varying several key treatment factors, including the initial pH, PAA concentration, and UFe-CN dosage. More importantly, the excellent practicality of UFe-CN/PAA was demonstrated by systematically evaluating the impact of the water matrix, catalyst regeneration capability, and wastewater treatment efficiency. Overall, this study provides a significant understanding of •OH-dominated PAA activation and an effective catalyst development paradigm to facilitate the practical application of PAA-based Fenton-like oxidation.

Parent Perception of Child's Behavior during the Initial Dental Visit among Children with Autism Spectrum Disorder: A Cross Sectional Study.

(1) Background: The purpose of this study was to evaluate parent perception of behavior and level of cooperation to determine the success of a dental appointment with a child with autism spectrum disorder (ASD). (2) Methods: pre-treatment form, task analysis (TAS), and Frankl scale scores were extracted from patient charts. Values were calculated for patient demographics and other health characteristics (N = 235). Regression models were constructed to examine the success level during the first dental appointment (measured by TAS and Frankl scores) by several factors. (3) Results: The model to test patient characteristics: age, gender, ethnicity, and verbal communication, Hispanic ethnicity significantly predicted the TAS score, F (4, 191) = 2.45, p = 0.03 [95% CI -17.18, -3.53], and age significantly predicted the Frankl score, F (4, 194) = 5.17, p = 0.00 [95% CI 0.04, 0.12]. There was a significant association between parent perception of behavior and Frankl scores, F (2, 202) = 7.68, p = 0.00 [ 95% CI -0.11, -0.02]. (4) Conclusion: The results indicate that ethnicity and age play a role in successful outcomes during the dental appointment. Additionally, parent perception of their child's behavior significantly predicted the Frankl score, thus coordinating with parents during the dental appointment can be a key factor in treatment planning for productive dental visits.

Effect of drug use calendar on adherence to iron chelation therapy in young thalassemia patients.

Background:Regular blood transfusions in thalassemia patients can lead to severe complications and iron chelation therapy is required as a treatment. Thalassemia is common in Thailand and the drugs used in iron chelation therapy are deferoxamine and deferiprone. Adherence to the therapy is a key factor for treatment success.Objective:To assess the impact of a drug use calendar on deferiprone and deferoxamine adherence in young thalassemia patients.Methods:A total of 86 young thalassemia outpatients at a Thai tertiary care hospital were recruited into the study. Patients were stratified into two groups based on self-assessment of adherence using a visual analogue scale. One group (n=41) was given a calendar with the schedule of drug use in addition to counselling as standard pharmaceutical care. The second group (n=45) only received the counselling. Adherence to iron chelation therapy was assessed by deferiprone pill or deferoxamine vial counts on six visits (V1 to V6) and results were compared between visits and groups using a multilevel linear regression model. Change in serum ferritin levels after 6 visits (n = 81) were compared using a linear regression model.Results:Adherence significantly increased in both the calendar and non-calendar groups for deferiprone mono- and combination-therapy and for deferoxamine monotherapy. In the calendar groups, average adherence increased by between 2.05 and 5.66% per visit compared to increases of 0.31 to3.92% per visit in the non-calendar groups. A significant difference in the increase in adherence per visit between the calendar and non-calendar groups was only observed for deferiprone monotherapy (3.03% SEM = 0.49vs 1.42% SEM =0.49, respectively, P-value = 0.0078). The serum ferritin level decreased in the calendar group by 20.25ng/mL (SEM = 23.80) and increased in the non-calendar group by 59.63 ng/mL (SEM = 23.01, P-value = 0.0147).Conclusion:Provision of a drug use calendar improved adherence to deferoxamine and deferiprone and decreased serum ferritin levels in young Thai thalassemia patients over the improvements obtained from standard counselling.

Neuronal Correlates of Small Animal Phobia in Human Subjects through fMRI: The Role of the Number and Proximity of Stimuli.

Brain regions involved in small-animal phobia include subcortical and cortical areas. The present study explored the neuronal correlates of small-animal phobia through fMRI data to determine whether a manipulation of number and proximity parameters affects the neurobiology of the processing of feared stimuli. The participants were 40 individuals with phobia and 40 individuals without phobia (28.7% male and 71.3% female). They watched videos of real and virtual images of spiders, cockroaches and lizards in motion presented more or less nearby with one or three stimuli in the different conditions. The results suggested a differential brain activity between participants with and without phobia depending on the proximity and number of phobic stimuli. Proximity activated the motor response marked by the precentral gyrus and the cingulate gyrus. By contrast, the number of stimuli was associated with significant sensory activity in the postcentral gyrus and ventromedial prefrontal cortex. We also observed a greater activity in the occipital cortex when exploring the number compared to the proximity factor. Threatening stimuli presented nearby and those presented in greater numbers generated an intense phobic response, suggesting a different emotion regulation strategy. Based on these findings, exposure therapies might consider including proximity to the threat and number of stimuli as key factors in treatment.

Atorvastatin Combined with Low-Dose Dexamethasone Treatment Protects Endothelial Function Impaired by Chronic Subdural Hematoma via the Transcription Factor KLF-2.

ObjectiveOur previous study showed that the combination therapy with atorvastatin and low-dose dexamethasone protected endothelial cell function in chronic subdural hematoma (CSDH) injury. In this study, we aimed to investigate the mechanism underlying the effects of this combination therapy on CSDH-induced cell dysfunction.MethodsMonocytes and endothelial cells were cocultured with CSDH patient hematoma samples to mimic the pathological microenvironment of CSDH. Monocytes (THP-1 cells) and endothelial cells (hCMEC/D3 cells) were cocultured in a transwell system for 24 h before stimulation with hematoma samples diluted in endothelial cell medium (ECM) at a 1:1 ratio. Tight junction markers were detected by Western blotting, PCR and immunofluorescence. hCMEC/D3 cells were collected for Western blot and PCR analyses to detect changes in the expression levels of vascular cell adhesion molecule (VCAM-1), intercellular adhesion molecule (ICAM-1), and Kruppel-like factor 2 (KLF-2). The IL-6, IL-10 and VEGF levels in the supernatant were measured by enzyme-linked immunosorbent assay (ELISA).ResultsKLF-2 expression in endothelial cells was decreased after stimulation with CSDH patient hematoma samples, but combination therapy with atorvastatin and low-dose dexamethasone reversed this trend. KLF-2 protected injured cells by increasing the expression of VE-cadherin and ZO-1; attenuating the expression of VCAM-1, ICAM-1, IL-6 and VEGF; and enhancing the expression of IL-10, all of which play pivotal roles in endothelial inflammation. Moreover, the effect of combination therapy with atorvastatin and low-dose dexamethasone was obviously reduced in endothelial cells with KLF-2 knockdown compared with normal cells.ConclusionCoculture with hematoma samples decreased KLF-2 expression in human cerebral endothelial cells. Combination therapy with atorvastatin and low-dose dexamethasone counteracted hematoma-induced KLF-2 suppression in human cerebral endothelial cells to attenuate robust endothelial inflammation and permeability. KLF-2 plays an important role in drug therapy for CSDH and may become the key factor in treatment and prognosis.

Routine feasibility of postoperative chemoradiotherapy in head and neck squamous cell carcinoma at high risk of recurrence

ObjectiveTo assess the feasibility in routine practice of postoperative chemoradiotherapy in head and neck squamous cell carcinoma (HNSCC) at high risk of recurrence. MethodA single-center retrospective study recruited all patients receiving postoperative cisplatin chemoradiotherapy for HNSCC at high risk of recurrence. The main endpoints were the rate of complete postoperative chemoradiotherapy and the impact of various clinical factors. Secondary endpoints comprised the impact of completion of therapy on survival and on acute and late toxicity. ResultsOne hundred and six patients were included. 24.5% showed severe comorbidity. Chemoradiotherapy was complete in 61 patients (57.5%). Radiation therapy was interrupted for >3 days in 16 patients (15.1%). The 3rd concomitant cisplatin course could not be implemented in 34 patients (32.1%). Low pre-treatment glomerular filtration rate was significantly associated (p=0.003) with treatment interruption; >5% weight-loss during treatment showed suggestive association (p=0.026). Completion of treatment was not associated with any significant difference in overall survival (p=0.441) or progression-free survival (p=0.81). 14.9% of patients showed post-treatment kidney failure; there were 10 cases of osteoradionecrosis (9.4%). ConclusionThe rate of complete postoperative chemoradiotherapy was comparable to that reported in clinical trials, despite frequent comorbidity and poor nutritional status. Early nutritional support is a key factor for treatment under optimal conditions.

Factors Influencing the Prescribing Preferences of Physicians for Drug-Naive Patients with Type 2 Diabetes Mellitus in the Real-World Setting in Japan: Insight from a Web Survey.

IntroductionThe Japanese guidelines for type 2 diabetes mellitus (T2DM) emphasize individualization of treatment based on patient need and encourage physicians to select an appropriate oral antidiabetes drug (OAD). However, limited evidence is available on the factors influencing the selection by physicians (diabetes specialists and nonspecialists) of the first-line OAD to treat drug-naive patients with T2DM. A survey was designed to explore the treatment factors and patient characteristics that influence physicians when they choose an initial OAD to prescribe to a drug-naive patient with T2DM in a real-world setting in Japan.MethodsThe 25-min web-based online survey consisted of simple and focused multiple-choice questions, and was circulated to physicians across eight selected regions in Japan. The primary endpoints were the proportions of physicians who considered particular treatment factors and patient characteristics when selecting the appropriate treatment for drug-naive T2DM patients.ResultsA total of 491 physicians participated in the survey. Dipeptidyl peptidase-4 inhibitors (DPP-4is) were the most-preferred first-line OADs, followed by metformin, of both specialists (69% vs. 60%) and nonspecialists (73% vs. 47%). The most influential factors when a DPP-4i was selected were found to be glycated hemoglobin (HbA1c), postprandial glucose (PPG)-lowering effect, and a low risk of hypoglycemia, which were considered by > 80% of physicians, whereas the key factors when metformin was selected were improvement in insulin resistance, low cost, low risk of hypoglycemia, and PPG- and HbA1c-lowering effects, which were considered by > 85% of physicians. Regression analysis revealed that the dominant reason for choosing DPP-4is over metformin was their ease of use in patients with renal impairment, whereas the dominant reasons for choosing metformin over DPP-4is were improvement in insulin resistance and low cost. The key patient characteristics driving the choice of DPP-4is or metformin as the first-line OAD by physicians were similar to those that influenced the treatment intensification decision (DPP-4is: PPG and renal function; metformin: age, BMI, insulin resistance, and renal function).ConclusionIn Japan, DPP-4is are the preferred first-line OADs, followed by metformin. The key treatment factors and patient characteristics considered when selecting DPP-4is or metformin are similar for both specialists and nonspecialists. These results may prompt further discussion of the differences in T2DM treatment between Japan and other counties.FundingNovartis.

Mucoadhesive Cationic Polypeptide Nanogel with Enhanced Penetration for Efficient Intravesical Chemotherapy of Bladder Cancer.

Initially, chemotherapy is effective for treatment of bladder cancer after transurethral resection of the bladder. However, certain patients progressively become unresponsive after multiple treatment cycles, which results from the rapid and almost complete excretion of clinically used formulations of antineoplastic agents with urinary voiding. Improving the mucoadhesiveness and penetrability of chemotherapeutic drugs are key factors in treatment of advanced bladder cancer. Here, a smart disulfide‐crosslinked polypeptide nanogel of poly(l‐lysine)–poly(l‐phenylalanine‐co‐l‐cystine) (PLL–P(LP‐co‐LC)) is developed to deliver 10‐hydroxycamptothecin (HCPT) for treatment of orthotopic bladder cancer. The positively charged PLL–P(LP‐co‐LC) can significantly prolong the retention period and enhance the tissue permeability of HCPT within the bladder wall of rat. Moreover, the reduction‐responsive polypeptide nanogel (i.e., NG/HCPT) possesses the capability to accurately and rapidly deliver HCPT in bladder cancer cells. NG/HCPT can significantly inhibit proliferation of human bladder cancer 5637 cells in vitro and enhance antitumor activity toward an orthotopic rat bladder cancer model in vivo. This work demonstrates that the smart polypeptide nanogel may function as a promising drug‐delivery system for local chemotherapy of bladder cancer with unprecedented clinical benefits.

An agent-based platform for the study of watersheds as coupled natural and human systems

This study describes the architecture and capabilities of an open source agent-based Java platform that permits the systematic study of interactions among hydrology, climate, and strategic human decision-making in a watershed over time. To demonstrate the platform's use and capabilities, an application is presented in accordance with ODD protocol requirements that captures, in simplified form, the structural attributes of the Squaw Creek watershed in central Iowa. Illustrative findings are reported for the sensitivity of farmer and city social welfare outcomes to changes in three key treatment factors: farmer land-allocation decision method, farmer targeted savings, and levee quality effectiveness for the mitigation of city flood damage.

Clinical switching time of sequential mechanical ventilation on patients with chronic obstructive pulmonary disease with type II respiratory failure

Objective To study clinical switching time of sequential mechanical ventilation on patients with chronic obstructive pulmonary disease with type Ⅱ respiratory failure. Methods The clinical data and laboratory data of 56 patients with chronic obstructive pulmonary disease combined with type Ⅱ respiratory failure, According to treatment intervention,56 cases were divided into the observation group and control group, each group with 28 cases, all adopted invasive mechanical ventilation patients, the control group adopted the trachea intubation and mechanical ventilation treatment; The observation group was the sequence through air treatment, The clinical effect of two groups was compared. Results The time of invasive mechanical ventilation in the observation group was(3.2±0.9)d,the control group was(20.2±1.6)d,the total length of hospital stay in the observation group was(13.6±2.5)d,the control group was(27.6±11.3)d,the cost in the observation group was(12 654.2±1 654.7)yuan, the control group was(29 658.9±3 654.2)yuan, the observation group was better than that of the control group, with statistical significance(P<0.05); The cure rates of the observation group was 89.29%,which was higher than 71.43%of the control group(χ2=6.34,P<0.05). Conclusion Sequential mechanical ventilation in patients with chronic obstructive pulmonary disease with type Ⅱ respiratory failure of clinical switching time is the key factor for treatment, can achieve good treatment effect, reduce the incidence of pneumonia,which is worthy of clinical promotion and further study. Key words: Ventilation, artificial; Pulmonary disease chronic obstructive; Respiratory failure

СТРАТЕГИЯ ФОРМИРОВАНИЯ ТОЛЕРАНТНОСТИ У ДЕТЕЙ С ПИЩЕВОЙ АЛЛЕРГИЕЙ

Food tolerance development is a key factor in treatment and prevention of food allergy in children. This paper focuses on factors contributing to the tolerance development, immunological mechanisms of food tolerance development, and possibilities of food allergy prevention. The tactics for complimentary food introduction in children with food allergy are also considered. The mechanism of a preventive effect of partially hydrolyzed milk formulas is analyzed. Based on the literature review, the importance of probiotics and prebiotics in food tolerance development is determined. It is shown that better understanding of underlying mechanisms involved in the development of tolerance to staple food may decrease the time needed to achieve remission of a large variety of food allergy in children and individualize the elimination diet.

Diagnosis and treatment of gallstone ileus

Gallstone ileus is a rare mechanical ileus,which was caused by discharge of giant gall bladder stone to the intestine.Understanding the causes of ileus is the key factor for treatment,and surgical treatment is the treatment of choice.An old patient with gallstone ileus was admitted to the Second Affiliated Hospital of Soochow University in April 2013.Preoperative X ray detection and computed tomography showed gallbladder wall thickening,formation of a sinus tract between the gall bladder and the duodenum,and intestinal ileus in the left iliac region (the diameter of the stone was about 4 cm).The patient received medical treatment for 3 days and then exploratory laparotomy + lithotomy.Gall bladder stones were not detected during the operation,so the gall bladder was preserved.The patient was followed up till December 2013,the sinus tract was disappeared under B sonography,and the cholecystitis was cured. Key words: Gallstone ileus; Internal biliary fistula; Cholelithiasis

Which Drugs For Which Patients?

‘Our current portfolio of novel molecular targets comprises a range of drugs which illustrate all the challenges that need to be faced if we are to provide credible answers to the question: ‘which drug for which cancers?’ We live in exciting times for drug development in cancer. For decades, oncologists have relied on cytotoxic chemotherapy as the major form of systemic cancer treatment. Increasingly however, the untoward side effects of these agents on normal cells has led to a demand for new drugs with a much greater degree of specificity for cancer cells. After several fallow years, the painstaking work in science laboratories around the world, which has focused on understanding the molecular basis of cancer, is beginning to bear fruit. Novel ‘molecular-targeted’ agents are now approved for treating a range of cancers. These are centered on a rational mechanism-based approach to drug development, generally involving the inhibition of key intracellular signalling pathways in cancer cells. In some cases, significant survival benefits resulting from this treatment can be clearly seen. However, this success brings with it major problems. The primary one is the challenge of patient selection. Current data indicates that, with one or two exceptions, this type of approach might only be helpful in a relatively small proportion of the total patients with the disease in question. The second problem is that pharmaceutical companies will have made major investments in research and development over a period of years to bring the agent to market, and to recoup these costs, novel drugs may well be extremely expensive. Healthcare systems around the world will cope with this in different ways, but it is clearly going to be both desirable and necessary to encourage investment not just in molecular therapeutics, but also in molecular diagnostics, the aim of which is better characterisation of tumors to be treated. The picture, of course, is complicated, and is made more complex by the fact that the mechanism through which a new agent is demonstrated to exert its antitumor effect in an experimental model may not necessarily hold true in clinical reality. Our current portfolio of novel molecular targets comprises a range of drugs that illustrate all the challenges that need to be faced if we are to provide credible answers to the question: ‘which drugs for which patients?’ Let me give some examples. For a minority of women with breast cancer, amplification of the HER2 neu oncoprotein is a key factor in treatment. Women whose tumors have fluorescence in situ hybridization (FISH)defined amplification should now have access to treatment with the specific monoclonal antibody, traztuzumab (Herceptin ® ). Randomized trials have demonstrated the efficacy of this therapy in both the adjuvant treatment of breast cancer [1] and in the treatment of metastatic disease [2] in this clearly-specified population of patients. Importantly, in most cases lack of evidence for amplification indicates that this expensive treatment is not appropriate. Unfortunately, traztuzumab illustrates the exception rather than the rule.

Section 3 discussion: Overview of major trials and key factors in treatment

Section 3 discussion: Overview of major trials and key factors in treatment