Longer Treatment Times Research Articles

Predicting Rates of Angular Correction After Hemiepiphysiodesis in Patients With X-Linked Hypophosphatemic Rickets.

Patients with X-linked hypophosphatemic rickets (XLH) often develop coronal plane knee deformities despite medical treatment. Hemiepiphysiodesis is an effective way to correct coronal plane knee deformities in skeletally immature patients, but a full understanding of the rate of angular correction after hemiepiphysiodesis in XLH patients, compared with idiopathic cases is lacking. We retrospectively reviewed charts of 24 XLH patients and 37 control patients without metabolic bone disease who underwent hemiepiphysiodesis. All patients were treated with standard-of-care medical therapy (SOC=active vitamin D and phosphate salt supplementation) in our clinical research center and had a minimum of 2-year follow-up after hemiepiphysiodesis. Demographic data as well as complications, repeat procedures, or recurrence/overcorrection were recorded. Standing lower extremity radiographs were evaluated before the surgical intervention and at subsequent hardware removal or skeletal maturity, whichever came first. Mean axis deviation, knee zone, mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle were measured on each radiograph. The rate of angular correction was calculated as the change in mLDFA and medial proximal tibial angle over the duration of treatment. The magnitude of the initial deformity of the distal femur was greater in XLH patients as compared with control for varus (XLH mLDFA 97.7 +/- 4.9 vs. Control mLDFA 92.0 +/- 2.0 degrees) and valgus (XLH mLDFA 78.7 +/- 6.2 vs. Controls mLDFA 83.6 +/- 3.2 degrees). The rate of correction was dependent on age. When correcting for age, XLH patients corrected femoral deformity at a 15% to 36% slower rate than control patients for the mLDFA (>3y growth remaining XLH 0.71 +/- 0.46 vs. control 0.84 +/- 0.27 degrees/month, <3y growth remaining XLH 0.37 +/- 0.33 vs. control 0.58 +/- 0.41 degrees/month). No significant differences were seen in the rate of proximal tibia correction. XLH patients were less likely to end treatment in zone 1 (55.0% XLH vs. 77.8% control). XLH patients had longer treatment times than controls (19.5 +/- 10.7 vs. 12.6 +/- 7.0mu, P value <0.001), a higher average number of secondary procedures than controls (1.33 +/- 1.44 vs. 0.62 +/- 0.92 number of procedures), a higher rate of overcorrection than controls (29.2% vs. 5.4%), and a higher rate of subsequent corrective osteotomy than controls (37.5% vs. 8.1%). There was no significant difference in the rate of complications between groups (8.3% vs. 5.4%). Patients with XLH undergoing hemiepiphysiodesis have a 15% to 36% slower rate of femoral deformity correction that results in longer treatment times, a higher likelihood to undergo more secondary procedures, and a lower likelihood to reach neutral mechanical alignment. This study provides important information to guide the timing and treatment of patients with XLH and coronal plane knee deformities. In addition, results from this study can be educational for families and patients with respect to anticipated treatment times, success rates of the procedure, complication rate, and likelihood of needing repeat procedures.

Bacterial Sterilization Using Non-Thermal Plasma Method Surface Dielectric Barrier Discharge (SDBD): Effect of Treatment Duration on Colony Count, DNA, Protease Enzymes, and Cell Morphology

The ability of Escherichia coli to become increasingly resistant to sterilization has resulted in high cases of this bacterial infection. To overcome this problem, a new method is needed. The circuit design uses 2 parallel plates of copper material. The first plate is HV electrode and second plate is ground electrode which is separated by a dielectric layer. Non-thermal plasma with surface dielectric barrier discharge is generated using a 20 VDC voltage source and then transformed into a high voltage source to generate plasma. Distance between plasma source and fixed sample is 3 mm. OES is used to observe reactive species produced in plasma indicated by magnitude of intensity at certain wavelengths. SDBD non-thermal plasma could be used to inactivate bacteria depending on treatment time. The longer treatment time, greater inactivation ability. For the number of colonies after being treated for 120 s, namely 4.33×107 CFU/mL, it was much lower than control, which was 409×107 CFU/ml. For DNA after being treated for 120 s, results of genome from Escherichia coli were no longer visible or faded, marked by a DNA concentration of 8.18 ng/ul, far lower than the control DNA concentration of 124.44 ng/ul. For the activity of the protease enzyme, the time variation of 105 s had the smallest activity value of the protease enzyme, namely 35.375 U/mL compared to control, which was 52.307 U/mL whereas for cell morphology after 120 s treatment showed increasingly severe cell damage observed using SEM. Non-thermal plasma SDBD configurations can be used to inactivate or kill bacteria. Effectiveness or capability of non-thermal plasma also depends on the treatment time. SDBD nonthermal plasma ability increases with the longer treatment time. HIGHLIGHTS In this research, a non-thermal plasma method of surface dielectric barrier discharge (SDBD) for Escherichia coli sterilization was developed. The results of research on inactivation of Escherichia coli bacteria using non-thermal plasma SDBD showed that the configuration of non-thermal plasma SDBD could be used to inactivate or kill bacteria. The effectiveness or capability of non-thermal plasma also depends on the treatment time. SDBD non-thermal plasma capability increases with longer treatment time. GRAPHICAL ABSTRACT

Zero-water discharge and rapid natural dyeing of wool by plasma-assisted spray-dyeing

The application of plasma on textiles is a highly beneficial technique to improve dyeability and reduce the consumption of water, energy, and time. This is advantageous for the industries to demonstrate high productivity and quality of the product but at a lower cost. Plasma treatment usually is applied as a pre-treatment before the conventional dyeing process, where the generation of dye wastewater remains a challenge. Plasma post-treatment can make a huge difference in reducing the dye wastewater; however, this has received little attention and more specifically the effectiveness of plasma on natural dye fixation is unknown. Natural dyes from waste, such as onion skin (Allium cepa L.) are greatly abundant and a low-cost green option for sustainable dyeing of textiles. In this study, a clean method of dyeing wool fabric with onion skin is proposed using a plasma-assisted spray-dyeing technique with no wastewater discharge. Four different plasma parameters were used varying the plasma operating power (40 W and 64 W) and treatment duration (30 s and 60 s). Mordanting and dyeing were done by a successive spraying-drying method in multiple rounds to reach the identical shade of a parallelly conducted conventional dyeing process. The removal of the cuticle layer of wool by plasma treatment was perceived from the morphology of the treated fabric, possibly contributing to the wettability. A higher plasma operating power and longer treatment time were beneficial and affected the overall dyeability. The chemical structure of wool showed a higher hydroxyl peak intensity after dyeing and a lower peak intensity of C–H groups after plasma post-treatment. The colour fastness properties (washing and crocking) improved after plasma post-treatment and confirmed the possible attachment of unfixed dyes with fabric. Overall, the time and energy consumed by the plasma-assisted spray-dyeing technique was nearly one-third of conventional dyeing, with no wastewater generation and led to a better colour strength (20.4 compared to 15.8) and similar colour fastness. Results showed the great potential for this newly proposed method as a sustainable textile dyeing alternative.

Forced Precipitation Experiments for Study of the Electromagnetic Treatment of Water

AbstractThe objective of this research is to determine the effect of the electromagnetic equipment TK3K to prevent incrustations in pipes. A method of forced precipitation of calcium carbonate, mixing solutions of Ca(NO3)2 and Na2CO3 with tap water, indicates differences in the temporal evolution of turbidity, absorbance, and in the final size of the particles formed, which makes it possible to distinguish between treated and untreated water. The latter presents higher values of parameters analyzed than the treated one. A longer treatment time does not produce different results, while an increase in temperature causes a greater decrease. Since there is no immediate technique on the market to verify the effect of electromagnetic treatment, this method, with temperature control, is simple and fast.

Aflatoxin M1 degradation using high voltage atmospheric cold plasma (HVACP) technology

ABSTRACT Aflatoxins are one of the highly toxic secondary metabolites with high decomposition temperatures, ranging from 237 °C to 306 °C. Therefore, non-thermal treatments are preferred to ensure safe food while preserving food quality. High voltage atmospheric cold plasma (HVACP) is a novel non-thermal technology with the potential to reduce contaminants (e.g. mycotoxins) owing to reactive species such as ozone. Therefore, the aim of this study was to investigate the efficacy of HVACP to degrade Aflatoxin M1 (AFM1) in pure water. A dielectric barrier discharge HVACP was performed at 90 kV using modified air (MA65: 65% O2, 30% CO2, 5% N2) fill gas for 1, 3, and 5 min in a direct and indirect mode with no post-treatment or 4.0 h post-storage at room temperature. The chemical properties of water were evaluated. Ozone concentration in both gas and liquid phases was also measured. A 77% reduction of AFM1 was observed after 1 min of direct treatment with no post-treatment storage. The nitrate and peroxide contents after 1 min of direct treatment were 4.50 ± 0.70 and 9.5 ± 0.70 mg/L, respectively. Longer treatment time and direct mode of exposure resulted in a higher ozone concentration in either the gas or liquid phase. These results demonstrate the potential of HVACP as a non-thermal treatment for reducing AFM1 concentration. HVACP was capable of significantly degrading AFM1 using a very short treatment time and 4.0-h post-treatment storage.

Construction of hydrophobic-hydrophilic microfluidic patterns with controlled wettability on PVDF filter paper surface using maskless microplasma scanning

Paper-based microfluidic analytical devices (μPADs) have attracted increasing interest due to their unique advantages. Localized hydrophilization on hydrophobic paper surfaces to form the microfluidic patterns and their wettability control are the key issues in μPADs preparation. This paper introduces a novel method to construct hydrophobic-hydrophilic microfluidic patterns on the surface of the Poly(vinylidene fluoride) (PVDF) filter paper by maskless microplasma writing. The hydrophilic performances and surface morphology of the patterns were characterized by water contact angle (WCA) and scanning electron microscopy (SEM). Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) were used to analyze their chemical compositions. The results showed that paper surface changed from hydrophobic to hydrophilic and its wettability can be controlled through plasma parameters adjustment. PVDF layer was gradually removed from the filter paper and the fluorine-containing groups on paper surface of the micropatterns decreased with increasing microplasma treatment time. Besides, the polar functional groups (e.g. –C=O) also appeared and increased with longer treatment time. Finally, the mechanism of the microfluidic patterns construction by microplasma was discussed, and the microfluidic pattern with the pattern “H” were demonstrated and successfully constructed. This work shows great potential for simple, fast, environmental friendly and low-cost construction of μPADs.

A Deep Learning Framework for Classifying and Evaluating Yoga Exercises

Yoga is a type of physical activity that combines physical postures with breathing techniques. Cardiovascular disease is the leading cause of illness and mortality. Yoga's potential involvement in cardiac recovery can be incorporated into cardiovascular rehabilitation. Classifying and evaluating yoga exercises using a deep learning framework plays a significant role in postoperative recovery. Home based rehabilitation often suffers from a lack of patient adherence to prescribed exercise routines, resulting in longer treatment times and higher healthcare expenses. This study proposes a framework for classifying and evaluating the quality of yoga exercises. The ConvNet followed by the deep belief network model is used to create quality scores for input movements to evaluate the quality of yoga asanas. Additionally, various machine learning algorithms are deployed to identify the best performing algorithm. The proposed framework is tested using the COCO dataset and the publicly available dataset from KAGGLE. The model is implemented using a three stage pipeline. In the first stage, an estimator and detector model is used for feature extraction. In the second stage, restricted Boltzmann machines are used for dimensionality reduction in two steps: The forward pass and the backward pass. Finally, the ConvNet followed by the deep belief network is used to classify yoga postures. The quaternion data is treated as a multivariate Gaussian variable to create Markov random fields. To quantify yoga asanas, the Markov random fields network is triggered, and the resulting quaternion point is compared to standard pose data, increasing the likelihood that the yoga position is correct. The importance of our study is that it allows participants to watch their movement in real-time and to obtain a numerical estimate of the accuracy of their yoga stance. Using this method, we were able to achieve a precision of 99.99%, which was previously unattainable on this dataset. Our model is more robust than previous models in terms of performance.

Effect of Cryogenic Treatment on Microstructure and Mechanical Properties of Al0.6CrFe2Ni2 Dual-Phase High-Entropy Alloy

The contradiction between strength and ductility limits the application of high-entropy alloys (HEAs). To simultaneously improve the strength and ductility of HEAs, the cryogenic treatment was proposed and applied in this paper. The Al0.6CrFe2Ni2 HEA with dual-phase structure was selected as the experimental material for cryogenic treatment. The microstructure and mechanical properties of the HEA in an as-cast and cryogenically treated state were analyzed in detail. The results showed that the grain size of equiaxed crystal in the alloy decreased continuously by prolonging the cryogenic treatment time, and the average value was 44.6 μm for the cryogenically treated HEA at the time of 48 h, which was 46.5% lower than that of the as-cast alloy. The number and size of ordered body-centered cubic (B2) spherical nanophases embedded in the body-centered cubic (BCC) structured inter-dendritic region, however, increased continuously by extending the cryogenic treatment time. The cryogenic treatment also made more slip systems activate, cross-slip occurred in the alloy, and a large number of stacking faults were found in the transmission electron microscopy (TEM) microstructure for the alloy that underwent a long time in cryogenic treatment. The yield strength of the Al0.6CrFe2Ni2 HEA was gradually increased with the increase in cryogenic treatment time, and the maximum yield strength of the 48 h cryogenically treated alloy was 390 MPa, which was 39.3% higher than that of the as-cast. This increase in mechanical properties after cryogenic treatment was attributed to the refinement of grains and the large precipitation of nanophases, as well as the appearance of cross-slips and stacking faults caused by cryogenic treatment.

Initial clinical applications treating pediatric and adolescent patients using MR-guided radiotherapy.

To demonstrate the clinical applications and feasibility of online adaptive magnetic resonance image guided radiotherapy (MRgRT) in the pediatric, adolescent and young adult (AYA) population. This is a retrospective case series of patients enrolled onto a prospective study. All pediatric (age < 18) and AYA patients (age< 30), treated on the Elekta Unity MR linear accelerator (MRL) from 2019 to 2021 were enrolled onto a prospective registry. Rationale for MRgRT included improved visualization of and alignment to the primary tumor, re-irradiation in a critical area, ability to use smaller margins, and need for daily adaptive replanning to minimize dose to adjacent critical structures. Step-and-shoot intensity-modulated radiation treatment (IMRT) plans were generated for all Unity patients with a dose grid of 3 mm and a statistical uncertainty of < 1% per plan. A total of 15 pediatric and AYA patients have been treated with median age of 13 years (range: 6 mos - 27 yrs). Seven patients were <10 yo. The clinical applications of MRgRT included Wilms tumor with unresectable IVC thrombus (n=1), Ewing sarcoma (primary and metastatic, n=3), recurrent diffuse intrinsic pontine glioma (DIPG, n=2), nasopharyngeal carcinoma (n=1), clival chordoma (n=1), primitive neuroectodermal tumor of the pancreas (n=1), recurrent gluteo-sacral germ cell tumor (n=1), C-spine ependymoma (n=1), and posterior fossa ependymoma (n=1). Two children required general anesthesia. One AYA patient could not complete the MRgRT course due to tumor-related pain exacerbated by longer treatment times. Two AYA patients experienced anxiety related to treatment on the MRL, one of which required daily Ativan. No patient experienced treatment interruptions or unexpected toxicity. MRgRT was well-tolerated by pediatric and AYA patients. There was no increased use of anesthesia outside of our usual practice. Dosimetric advantages were seen for patients with tumors in critical locations such as adjacent to or involving optic structures, stomach, kidney, bowel, and heart.

Phototherapy of Pseudomonas aeruginosa-Infected Wounds: Preclinical Evaluation of Antimicrobial Blue Light (450-460 nm) Using In Vitro Assays and a Human Wound Skin Model.

Objective: To determine effective treatment strategies against bacterial infections of burn wounds with Pseudomonas aeruginosa, we tested different treatment regimens with antibacterial blue light (BL). Background: Infections of burn wounds are serious complications and require effective and pathogen-specific therapy. Hereby, infections caused by P. aeruginosa pose a particular challenge in clinical practice due to its resistance to many antibiotics and topical antiseptics. Methods: LED-based light sources (450-460 nm) with different intensities and treatment times were used. Antibacterial effects against P. aeruginosa were determined by colony-forming unit (CFU) assays, human skin wound models, and fluorescence imaging. Results: In suspension assays, BL (2 h, 40 mW/cm2, 288 J/cm2) reduced bacterial number (>5 log10 CFU/mL). Applying 144 J/cm2, using 40 mW/cm2 for 1 h was more effective (>4 log10 CFU) than using 20 mW/cm2 for 2 h (>1.5 log10 CFU). BL with low irradiance (24 h, 3.5 mW/cm2, 300 J/cm2) only revealed bacterial reduction in thin bacteria-containing medium layers. In infected in vitro skin wounds only BL irradiation (2 h, 40 mW/cm2, 288 J/cm2) exerted a significant antimicrobial efficacy (2.94 log10 CFU/mL). Conclusions: BL treatment may be an effective therapy for P. aeruginosa-infected wounds to avoid radical surgical debridement. However, a significant antibacterial efficacy can only be achieved with higher irradiances and longer treatment times (min. 40 mW/cm2; >1 h), which cannot be easily integrated into regular clinical treatment protocols, for example, during a dressing change. Further studies are necessary to establish BL therapy for infected burns among tissue compatibility and interactions with previous therapeutic agents.

Uterine prolapse: impact of the condition and practical advice.

Pelvic-organ prolapse is where organs such as the uterus move out of place; in some cases, they can protrude out of the body. It occurs when muscles extending from the pubic bone to the coccyx or the levator ani muscles become weak or are injured. Although it is not life-threatening, the condition can be life limiting, adversely affecting physiological processes, function and quality of life, with patients reporting years of pain, discomfort, humiliation and embarrassment. Uterine prolapse is often under-reported as women may feel resigned to a condition that is viewed as part of getting old or the menopause, or a consequence of childbirth; they may also feel embarrassed. Gynaecology has the fastest growing waiting lists of any NHS specialty, and women may wait a long time for treatment. This article focuses on uterine prolapse, management of symptoms from conservative self-help to surgical options, and includes a case study of a successful laparoscopic hysteropexy with bifurcated polypropylene mesh apical support procedure carried out by a skilled surgeon.

Interleukin 17A inhibitor secukinumab in the treatment of patients with psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis and characterized by various presentation, course, and response to treatment. A better understanding of the pathogenesis has led to the development of targeted therapeutic agents and innovative treatment strategies for PsA. The article is dedicated to a drug targeting interleukin-17A. Secukinumab is a fully human monoclonal antibody that selectively targets interleukin (IL) 17A, a pro-inflammatory cytokine involved in the pathogenesis of PsA. Secukinumab is the first antibody against IL 17 approved in many countries for PsA treatment in adult patients. In the Phase III FUTURE trial, secukinumab 150 and 300 mg subcutaneously showed high efficacy on disease activity in patients previously treated with non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and / or tumor necrosis factor (TNF) inhibitors and maintaining the effect for a long time of treatment (more than 5 years). In addition, in studies FUTURE 1 and 5 secukinumab suppressed structural joint damage and was associated with consistently low rates of radiological progression after 1–3 years of treatment. Treatment with secukinumab improved physical function and quality of life and was generally well tolerated in both short and long term. Secukinumab is effective in all key PsA domains and therefore represents a treatment option that may be an alternative to TNF inhibitors and other DMARDs in adult patients with PsA.

Investigation of Carbon Nanostructure Synthesis Pathway with Plasma Treatment of Ethanol

Plasma conversion of ethanol into carbon nanostructures is easily achieved by in-liquid plasmas but also possible with atmospheric pressure plasmas, where plasma forms in the gas phase over the liquid’s surface. Two plasma configurations were used – atmospheric pressure plasma jet (APPJ) and dielectric barrier discharge (DBD). These plasmas configurations should help reveal synthesis paths of different carbon allotropes. Moreover, this focus is on the determination of the importance of the in-liquid electrode material on nanostructure production and the possibilities of controlling nano-carbon allotropes by controlling plasma parameters. Plasma-liquid interaction was additionally influenced by an electrode placed under the treatment chamber or the addition of a graphite foil in the liquid ethanol. The experiments were conducted in ethanol with argon plasma, indicating an interesting pathway for converting ethanol into nanocarbons. Ethanol solution was analysed with UV-Vis spectroscopy, while carbon nanostructures were more thoroughly investigated with SEM and TEM. In the beginning, obtained carbon allotropes were mostly amorphous, whose size reduced with longer treatment times and structured carbon was synthesised.

Enhance the inactivation of fungi by the sequential use of cold atmospheric plasma and plasma-activated water: Synergistic effect and mechanism study

Cold atmospheric plasma (CAP) has been widely applied for microbe inactivation. Previous studies revealed that the inactivation efficiency could be improved with the sequential use of plasma-activated water (PAW) after the direct CAP treatment, while the mechanism requires further exploration. In this work, we employed a CAP jet device and investigated the inactivation effect of CAP combined with PAW treatment on two kinds of fungi (Saccharomyces cerevisiae and Aspergillus flavus), and particularly, we examined the synergistic effect by scrutinizing the roles of varied reactive species. Our experimental results showed that short-term CAP treatment combined with the continued long-term (e.g., 120 min) PAW treatment led to significant reduction of Saccharomyces cerevisiae/Aspergillus flavus, with the disinfection effect equivalentto the single CAP approach with much longer treatment time. The comparative analysis revealed that the inactivation of fungi was induced by different reactive oxygen and nitrogen species (RONS) during the combination of CAP and PAW treatments, which had different influences on the fungal morphology, membrane permeability, intracellular RONS and energy metabolism. In the first stage of CAP treatment, the plasma produced ·OH and 1O2, could directly destroy the structure of fungal wall and membrane, leading to cell death. While in the subsequent PAW treatment, the reactive nitrogen species (RNS) could enter cell and influence metabolic activities, leading inactivation of more fungi. The synergistic effect was attributed to the increasing of intracellular 1O2 and ONOO– induced membrane damage, causing the irreparable oxidative damage to mitochondria and energy metabolic system. This mechanistic study may thus provide a new guidance for the optimal application of low-temperature plasma technology in the application of fungal disinfection with high efficiency.

Purification of dense carbon nanotube networks by subcritical hydrothermal processing

Carbon nanotube (CNT)-reinforced composites are promising materials for high-performance, lightweight structures; however, homogeneous infiltration of CNTs by a matrix material is necessary to achieve desired mechanical properties. Critical to overcoming this challenge at scale is purification of CNT materials produced by floating-catalyst chemical vapor deposition. Here, we present a hydrothermal processing technique for purification of CNT yarns, wherein as-received material is exposed to superheated, subcritical water in a hydrothermal reactor. This process selectively removes amorphous carbon and acid impurities while preserving the yarn structure. We find this technique to be consistent and tunable, with processing time directly correlating to linear density reduction up to a saturation limit. Using commercially-available yarns, we find that after 4 h of treatment at 200 °C, the weight loss of the yarn under inert atmosphere is reduced from 12% to 5%, the atomic percentage of oxygen at the surface by 42%, and the I D /I G by 30%. In addition, the yarn specific strength (1.3 N/tex) is preserved, while the specific Young's modulus is significantly increased by 20% (79 to 95 N/tex). At longer treatment times, we obtain greater purity and higher specific Young's modulus, but at a substantial reduction in tensile strength, which we hypothesize results from eliminating amorphous carbon toughening CNT bundles. The reported method could be scaled to continuous processing in tandem with post-purification treatments, and appears broadly applicable to different continuous CNT networks.

Oxygen plasma cleaning of copper for photocathode applications: A MEIS and XPS study

MEIS and XPS studies have been conducted for a range of oxygen plasma treated copper samples (and one treated with Ar plasma), as part of a study of the preparation of photocathode surfaces. This procedure was seen to remove hydrocarbon contamination, but left an oxide film whose thickness depended on the treatment conditions used. The film thickness was seen to increase with longer treatment time and higher RF power levels with behaviour characteristic of a diffusion limited process. Annealing led to a removal of the oxide layer by diffusion of oxygen into the bulk of the samples. This indicates that where the oxide layer is sufficiently thin, it should be possible to produce a surface with low enough oxygen content to have adequate conductivity and high enough surface escape probability to allow photoemission at UV wavelengths. Ar plasma treatment was seen to result in a very thin oxide film which could satisfy these requirements and thus might be preferable. Data from single crystal copper samples showed similar total oxygen content for all the surfaces analysed.

A eficácia dos tratamentos para a dor neuropática

The neuropathic pain is a type of chronic pain that arises from an injury or disease of the somatosensory nervous system, central or peripheral origin. It is a heterogeneous range of pain syndromes, with different pathophysiological mechanisms and different degrees of intensity of signs and symptoms. As a result, there are several therapeutic resources, whether they are pharmacological, physical or cognitive, and obstacles to an adequate and effective treatment. From the advances in therapy alone, only a minority of patients achieve significant pain relief. To analyze available treatments for neuropathic pain and present the best pharmacological options. A literature review was carried out, using the descriptors "pain", "neuropathy", "treatment". The database used was PUBMED, with filters for full free text, systematic review and meta-analysis, from 2016 to 2021. This review found that there is evident efficacy when using gabapentin and pregabalin to relieve neuropathic pain. These drugs are neuromodulators of the antidepressant class, and both showed greater improvement than the placebo group. In addition, the use of vitamin B12 (methylcobalamin) and acupuncture was also shown to be effective, but on a smaller scale and with a longer treatment time. Studies on the treatment of neuropathic pain have increased over the years, which allows us to think about significant advances in the future. Currently, drugs such as Pregabalin and Gabapentin are used, or non-pharmacological methods such as acupuncture. Therefore, greater attention should be given to studies on treatments for this disease, aiming at the patient's well-being.

Evaluation of a New Inverse, Globally Convex Treatment Planning System Algorithm for Gamma Knife Radiation Surgery Within a Prospective Trial: Advantages and Disadvantages in Practical Application

PurposeA new inverse planning software called IntuitivePlan (IP) based on a global convex optimization algorithm was adopted for the Gamma Knife radiation surgery. We investigated IP's suitability for daily clinical use and its applicability for different cerebral entities. Methods and MaterialsFor 230 target volumes, IP was tested in a prospective trial. The computed treatment plans were compared with conventional expert preplans, which included forward planning by the expert and local internal optimization. Based on the same dose constraints, we used the default settings for the inverse calculation of the treatment plans. Plan quality metrics such as the Paddick conformity index were compared for both planning techniques with additional subdivisions into the 3 selectable IP planning strategies and different entity groups. ResultsIP calculated treatment plans of quality similar to that of preplans created by expert planners. Some plan quality metrics, especially those related to conformity and dose gradient, attained statistically significantly higher scores combined with high coverage for the inversely generated plans except for the selectivity optimizing strategy. Normal brain volume receiving 10 Gy or 12 Gy or higher (V10Gy or V12Gy) did not show significant differences for the coverage optimizing strategies. The IP software demonstrated significantly shorter planning times versus manual planning as well as greater numbers of isocenters, often associated with longer treatment times. In terms of total time, these differences almost balanced out again. ConclusionsOur results suggest that IP is advantageous for complex tumors. We observed general clinical significance for conformity and superiority for the selectivity optimizing strategy. In addition, the high-quality calculation from IP enables novices in the profession to achieve pre-treatment plans of a quality similar to that of expert planners. IP allows for optimizing the sparing of surrounding tissue and conformity for benign tumors within a short time. Thus, IP forms a solid basis for further planning on the treatment day.

Effects of continuous subcutaneous insulin infusion on the microstructures, mechanical properties and bone mineral compositions of lumbar spines in type 2 diabetic rats

BackgroundContinuous subcutaneous insulin infusion (CSII) for the treatment of type 2 diabetes (T2D) can improve the structure and strength of femur of rats, but the effect of CSII treatment on the lumbar spine of T2D rats is unknown. The purpose of this study is to investigate the effects of CSII on the microstructure, multi-scale mechanical properties and bone mineral composition of the lumbar spine in T2D rats.MethodsSeventy 6-week-old male Sprague–Dawley (SD) rats were divided into two batches, each including Control, T2D, CSII and Placebo groups, and the duration of insulin treatment was 4-week and 8-week, respectively. At the end of the experiment, the rats were sacrificed to take their lumbar spine. Microstructure, bone mineral composition and nanoscopic-mesoscopic-apparentand-macroscopic mechanical properties were evaluated through micro-computed tomography (micro-CT), Raman spectroscopy, nanoindentation test, nonlinear finite element analysis and compression test.ResultsIt was found that 4 weeks later, T2D significantly decreased trabecular thickness (Tb.Th), nanoscopic-apparent and partial mesoscopic mechanical parameters of lumbar spine (P < 0.05), and significantly increased bone mineral composition parameters of cortical bone (P < 0.05). It was shown that CSII significantly improved nanoscopic-apparent mechanical parameters (P < 0.05). In addition, 8 weeks later, T2D significantly decreased bone mineral density (BMD), bone volume fraction (BV/TV) and macroscopic mechanical parameters (P < 0.05), and significantly increased bone mineral composition parameters of cancellous bone (P < 0.05). CSII treatment significantly improved partial mesoscopic-macroscopic mechanical parameters and some cortical bone mineral composition parameters (P < 0.05).ConclusionsCSII treatment can significantly improve the nanoscopic-mesoscopic-apparent-macroscopic mechanical properties of the lumbar spine in T2D rats, as well as the bone structure and bone mineral composition of the lumbar vertebrae, but it will take longer treatment time to restore the normal level. In addition, T2D and CSII treatment affected bone mineral composition of cortical bone earlier than cancellous bone of lumbar spine in rat. Our study can provide evidence for clinical prevention and treatment of T2D-related bone diseases.

Analysing Subgroups and Treatment Discontinuation in a Finnish Cohort of Patients with Neovascular AMD

Purpose: We aimed to study the regional detailed visual outcome and treatment discontinuation of neovascular age-related macular degeneration (nAMD). Methods: Clinical records of 110 patients treated for nAMD at the sole referral centre in the Helsinki region were analysed retrospectively. The follow-up was up to the fourth year. Results: The mean visual acuity (VA) at baseline was 56.3 (SD 16.2) letters. The mean last VA at the first year was 59.7 (20.2), and the corresponding values for the second, third, and fourth years were 60.8 (20.6), 60.0 (19.0), and 59.7 (19.3). The mean difference from baseline was +3.39 (SD 14.6), +3.59 (17.6), +0.08 (18.9), and +3.08 (14.3). The number of patients declined each year, with only 51% of the patients being in treatment until the fourth year. The patients with shorter duration of follow-up tended to have a lower baseline VA, lesser gains, and an earlier decline in VA. The VA levels at the last visit were poorer in the shorter follow group. The initial VA response predicted later VA, whereas VA at baseline, age, or sex had no effect. However, the effect vanished with a longer time in treatment. Conclusions: Long-term VA stabilization was obtained in a regional material. Patients with neovascular AMD consist of cohorts with varying visual outcome and treatment time. Many of the patients benefit from the treatment for some time, however. When comparing real-world results, the outcome of the different follow-up time cohorts should be considered. This calls for new methods for analysing real-world nAMD treatment results.