Months Of Continuous Use Research Articles

Efficacy of pregabalin, amitriptyline, and gabapentin for neuropathic pain

Neuropathic pain largely influences the well-being of patients. Anticonvulsant and antidepressant medications, such as Pregabalin, Gabapentin, and Amitriptyline, are routinely prescribed as initial treatments for neuropathic pain. The study sample has a total of 270 patients who meet the inclusion criteria and are further distributed into three equally sized groups (A, B, and C). Group A was administered with Gabapentine 300mg, Group B with Pregabalin 75 mg, and Amitriptyline 10 mg to Group C. The occurrence of any adverse drug response was documented using the ADR reporting form, while the pain of the patient's post-medication was recorded using a numerical pain rating scale (NPRS). The comparison of the NPRS scores of all three groups "by using ANOVA test" both at baseline and after 15 days reveal that the differences between the three groups are statistically insignificant (p > 0.089). However, after one month of continuous use, the difference becomes slightly significant (I.e., p = 0.003). Gabapentin, pregabalin, and amitriptyline demonstrate similar effectiveness in alleviating neuropathic (NeP) pain. The study concludes that gabapentin is superior to both pregabalin and amitriptyline with fewer adverse effects, leading to improved patient adherence for long-term use.

Comparison of Mirena and Liletta levonorgestrel intrauterine devices for the treatment of endometrial intraepithelial neoplasia and grade 1 endometrioid endometrial cancer

ObjectiveCurrent standard nonsurgical management of endometrial intraepithelial neoplasia (EIN) and grade 1 endometrioid endometrial cancer (g1EEC) is the Mirena levonorgestrel intrauterine device (M−IUD). This retrospective study was designed primarily to determine noninferiority of the Liletta IUD (L-IUD) for pathologic regression of EIN and g1EEC compared to the M−IUD at 6 months of continuous use. Secondary objectives include to determine noninferiority as above at 3, 9, and 12 months of continuous use and to identify factors including DNA mismatch repair (MMR) status associated with pathologic regression after LNG-IUD use. MethodsA retrospective observational study was performed with patients treated for EIN or g1EEC and managed continuously with M- or L-IUD. Patients with recent (within 6 months) or concurrent progesterone use were excluded. For the EIN group, the noninferiority margin of odds ratio was predetermined to be 0.58, and for the g1EEC group it was 0.64. Results62 patients from an academic center and a safety-net hospital were identified with continuous M−IUD (n = 44) or L-IUD (n = 18) use for EIN or g1EEC. 85% of patients treated with L-IUD were from a safety-net hospital, which had 63% with public insurance. At 3/6/9 months, 54/71/73% of patients with M−IUD and 80/83/100% with L-IUD had pathologic regression of EIN (95% confidence interval of estimated odds ratio 1.00–2.07/0.84–2.03/0.69–2.10). Lifetime smoking status, not MMR status, was significantly associated with pathologic regression. ConclusionsL-IUD is an effective fertility-sparing treatment for EIN. L-IUD is noninferior to M−IUD for pathologic regression of EIN after 3,6, and 9 months. Further larger studies are warranted to validate findings in EIN and g1EEC.

Длительное использование нестероидных противовоспалительных препаратов у больных аксиальным спондилоартритом для подавления острого костномозгового воспаления в крестцово-подвздошных суставах

Long-term use of nonsteroidal anti-inflammatory drugs in daily therapeutic practice is not welcome and often causes rejection due to the potential for the development of a variety of adverse events. However, in axial spondyloarthritis, these drugs play the role of not only symptomatic therapy, but also modify the course of the disease. Therefore, they should be prescribed for a long period, much longer than that described in the instructions for the drug. A brief description of clinical cases of the use of various non-steroidal anti-inflammatory drugs lasting 3 or more months is presented. Against the background of good clinical efficacy, adverse events did not develop during many months of continuous use

Techno-economic and sustainability analysis of siloxane removal from landfill gas used for electricity generation

A technoeconomic analysis (TEA) and life cycle assessment (LCA) was conducted on the use of landfill gas (LFG) for electricity generation using an internal combustion engine. This study provides insights that can guide LFG waste to energy (WTE) operators on decisions concerning installation of contaminant removal from LFG for electricity generation. Four scenarios were analyzed; the first (Scenario 1) was a facility with a single siloxane removal unit (SREU) sized for 6 months of continuous use, the second (Scenario 2) was a facility with parallel SREUs sized for one month of use, the third (Scenario 3) was a facility with no SREU, and the fourth was a facility that flared all LFG captured. The TEA revealed that the chiller cost was over 50% the total purchase cost of the LFG pre-treatment system. When the complete LFG to electricity process was analyzed, the internal combustion engine had the highest percentage of total capital investment and the total annual cost. For the base case, it became economically beneficial to install a SREU at facilities with LFG flowrates greater than ∼2000 m3/h. Sensitivity analysis showed that at a base case of 1700 m3/h, LFG (50% CH4), and 50 mg/m3 D4, the net income of facilities in Scenarios 1 to 3 became positive at an electricity sales price greater than 5.5 cents/kWh. LCA revealed that Scenario 2 had the greatest CO2 emission reduction. Scenario 3 is observed to save less CO2 emissions as biogas flowrate increases due to frequent engine shutdowns. Although there are differences in the global warming potential (GWP 100) for Scenarios 1 to 3, with Scenario 2 being the best and Scenario 3 being the worst, the differences are very small. For this reason, economics alone are sufficient in decision making.

Reversed-phase capillary electrochromatography of pre-column derivatized mono- and oligosaccharides with three different ultraviolet absorbing tags

In this research report, an in house developed octadecyl monolithic (ODM) column has been exploited in the reversed-phase capillary electrochromatography (RP-CEC) of precolumn derivatized mono- and oligosaccharides with three different tagging agents, namely 1-naphthylamine (1-NA), 2-aminoanthracene (2-AA) and 3-amino-2,7-naphthalenedisulfonic acid (ANDSA). These three derivatizing agents, which differed in their charges, nonpolar characters and optical absorption properties, led to different RP-CEC elution patterns and UV detection signals. In fact, the limit of detection of the derivatized sugars were 50 µM for the ANDSA- and 1-NA-sugar derivatives and 35 µM for the 2-AA-sugar derivatives due to the presence of three fused aromatic rings in 2-AA versus 2 fused rings in the 1-NA and ANDSA tags. Furthermore, while the longer ANDSA-oligosaccharides eluted later than the shorter ones and the ANDSA-monosaccharides, 1-NA- and 2-AA-sugar derivatives necessitated the presence of borate ions at alkaline pH in the mobile phase to form in situ charged derivatives to facilitate their separation by RP-CEC, and the elution order was the reversal of that observed with the ANDSA-sugar derivatives; that is the mono- eluted later than the larger size oligosaccharides. In addition, plots of log tR vs. number of glucose residues (nGlc) for derivatized glucose and maltooligosaccharides yielded straight lines with slopes representing log η where η is the retention time modulus (i.e., ratio of retention time of two neighboring derivatives differing in one glucosyl residue). In the case of 1-NA and 2-AA derivatives, η was smaller than unity while it was greater than unity in the case of ANDSA-sugar derivatives because the elution occurred in the order of decreasing size of the homologous sugar derivatives in the former than in the later derivatives. The prepared ODM column was stable for more than a month of continuous use, a fact that allowed a good repeatability for intraday and interday analyzes.

Disruptive Therapy Using a Nonsurgical Orthodontic Airway Plate for the Management of Neonatal Robin Sequence: 1-Year Follow-up.

We recently published the 3-month follow-up of 2 neonates with Robin sequence whose mandibular hypoplasia and restricted airway were successfully treated with an orthodontic airway plate (OAP) without surgical intervention. Both infants were successfully weaned off the OAP after several months of continuous use. We present the course of OAP treatment in these patients with a focus on breathing, feeding, and facial growth during their first year of life. Both infants demonstrated stable mandibular projection, resolution of obstructive sleep apnea, and normal development.

Targeted Delivery of Chloroquine to Antigen-Presenting Cells Enhances Inhibition of the Type I Interferon Response.

Systemic lupus erythematosus (SLE) causes damaging inflammation in multiple organs via the accumulation of immune complexes. These complexes activate plasmacytoid dendritic cells (pDCs) via toll-like receptors (TLRs), contributing to disease pathogenesis by driving the secretion of inflammatory type I interferons (IFNs). Antimalarial drugs, such as chloroquine (CQ), are TLR antagonists used to alleviate inflammation in SLE. However, they require ∼3 months of continuous use before achieving therapeutic efficacy and can accumulate in the retinal pigment epithelium with chronic use, resulting in retinopathy. We hypothesized that poly(ethylene glycol)-b-poly(propylene sulfide) filamentous nanocarriers, filomicelles (FMs), could directly deliver CQ to pDCs via passive, morphology-based targeting to concentrate drug delivery to specific immune cells, improve drug activity by increased inhibition of type I IFN, and enhance efficacy per dose. Healthy human peripheral blood mononuclear cells were treated with soluble CQ or CQ-loaded FMs, stimulated with TLR agonists or SLE patient sera, and type I IFN secretion was quantified via multi-subtype IFN-α ELISA and MX1 gene expression using real-time reverse transcription-quantitative polymerase chain reaction. Our results showed that 50 μg CQ/mg FM decreased MX1 expression and IFN-α production after TLR activation with either synthetic nucleic acid agonists or immune complex-rich sera from SLE patients. Cellular uptake and biodistribution studies showed that FMs preferentially accumulate in human pDCs and monocytes in vitro and in tissues frequently damaged in SLE patients (i.e., kidneys), while sparing the eye in vivo. These results showed that nanocarrier morphology enables drug delivery, and CQ-FMs may be equally effective and more targeted than soluble CQ at inhibiting SLE-relevant pathways.

Treatment of periocular advanced basal cell carcinoma with Hedgehog pathway inhibitors: A single-center study and a new dedicated therapeutic protocol.

The management of difficult-to-treat periocular basal cell carcinoma (BCC) becomes very challenging in cases of delayed diagnosis, leading to the development of locally advanced BCC. The aim of this study was to evaluate the outcomes of Hedgehog pathway inhibitors (vismodegib and sonidegib) treatment in patients affected by periocular locally advanced BCC. We focused on the common adverse events and their correlation with the administration schedule, to determine a management protocol specific for the periocular area.This observational prospective study included a single-center case series with patients who were histologically confirmed to have periocular or orbital locally advanced BCC, treated with Hedgehog pathway inhibitors. All patients benefitted in terms of regression or stabilization of the neoplasm. In the first months of treatment, the HPIs were well tolerated, and the first important side effects appeared after about 5 months of continuous use of the drug.These data could lead to a new type of therapeutic scheme where neoadjuvant therapy could be followed by pulse therapy as an adjuvant to surgery.

Track segment automated characterisation via railway–vehicle–based random vibration signals and statistical time series methods

The feasibility of automated railway track segment characterisation, as part of a broader track condition based maintenance procedure, is explored via railway–vehicle–based random vibration signals and Statistical Time Series (STS) methods. In particular, three methods within a Multiple Model (MM) framework, which are founded on data-driven stochastic parametric models for the representation of the partial vehicle-rail dynamics, are employed. The random vibration signals are obtained from two sensors, which are mounted on the axlebox and the bogie frame, respectively, of an Athens Metro railway vehicle moving under three different speeds (60, 70 or 80 km/h). The performance assessment of the methods is based on two distinct track characterisation problems. The first corresponds to the characterisation of a specific track segment after 6 months of continuous use, while the second to the comparison between two nominally identical track segments which were installed with a 2 month time interval and are used by different numbers and types of trains. The results indicate deterioration of the track segment in the first characterisation problem and differences between the two nominally identical segments in the second. The superiority of the employed methods over a state-of-the-art method is also demonstrated via proper comparisons.

Relationship between heart failure and the risk of acute exacerbation of COPD

RationaleHeart failure (HF) management in chronic obstructive pulmonary disease (COPD) is often delayed or suboptimal.ObjectivesTo examine the effect of HF and HF medication use on moderate-to-severe COPD exacerbations.Methods and measurementsRetrospective...

How often should ring pessaries be removed or changed in women with advanced POP? A prospective observational study.

Introduction and hypothesisThis study aimed to evaluate the efficacy and safety of ring pessaries under continuous use for > 2 years. Our starting hypothesis was that their use without periodic removal, cleaning or replacement for between 24 to 48 months after insertion is safe and effective.MethodsThis was a prospective observational and descriptive study. One hundred one women who successfully completed the 24 first months of continuous use of a ring pessary were included and monitored for another 24 months. The objectives were to establish the percentage of patients maintaining its use 48 months after insertion, the reasons for discontinuation and the adverse events. Another purpose of this study was to determine the timing of replacement of the vaginal pessary in long-term users.ResultsOf the women, 92.1% (93/101) had successful pessary use, and it was discontinued by three patients (2.9%, 3/101); 76.2% (77/101) of the women continued pessary use after the end of the study, and in 16 (15.8%, 16/101) patients, after pessary removal, the prolapse disappeared and did not recur. Forty-five women (48.4%, 45/93) presented some adverse events that required temporary pessary removal. The most common one was an increase in vaginal discharge (73.3%, 33/45). In four women (8.9%, 4/45), the ring pessary was detected embedded in the vaginal epithelium.ConclusionsContinuous use of a ring pessary can be recommended for 2 years in hysterectomized women and for 4 years in non-hysterectomized women if there are no complications.

Результаты применения растительного комплекса Ренотинекс® у больных мочекаменной болезнью в раннем послеоперационном периоде

Introduction. The article analyzes the results of the clinical application of the herbal complex Renotinex®, which helps to normalize the function of the urinary tract, reduce pain, remove small stones from the kidneys and reduce the risk of recurrent stone formation. Materials and methods. At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, a prospective, single-center, randomized study was carried out from November 2019 to March 2020. All patients underwent contact ureterolithotripsy. The patients were divided evenly into 2 groups: group A (n = 30) – patients receiving Renotinex® from the first day after surgery (within 1 month), and group B (n = 30) – a control group of patients not receiving specific therapy. Results. After 1 month of continuous use of the drug, there was an increase in the percentage of calculi discharge after contact ureterolithotripsy, a decrease in the severity of pain, normalization of the temperature curve and the absence of subfebrile condition in all patients. Conclusion. Renotinex® has a lithokinetic effect, its active ingredients contribute to the prevention of infectious and inflammatory complications of urolithiasis.

Preparation of monolithic polymer-magnetite nanoparticle composites into poly(ethylene-co-tetrafluoroethylene) tubes for uses in micro-bore HPLC separation and extraction of phosphorylated compounds

This paper describes the fabrication of a novel microbore monolithic column modified with magnetite nanoparticles (MNPs) prepared in a poly(ethylene-co-tetrafluoroethylene) (EFTE) tubing, and its application as stationary phase for the chromatographic separation of phosphorylated compounds. In order to obtain the composite column, a two-step procedure was performed. The formation of a glycidyl methacrylate-based monolith inside the activated ETFE tube was firstly carried out. Then, two incorporation approaches of MNPs in monoliths were investigated. The generic polymer was modified with 3-aminopropyltrimethoxysilane (APTMS) to be subsequently attached to MNP surfaces. Alternatively, APTMS-coated MNPs were firstly prepared and subsequently used for attachment onto the monolith surface through reaction of epoxy groups present in the generic monolith. This last strategy gave a reproducible layer of MNPs coated onto the polymer monolith as well as robust and permeable chromatographic columns. The retention behaviour of this MNP-based composite monolithic column was studied by using small phosphorylated compounds (adenosine phosphates). It was found that the retention of model analytes was ruled by partitioning and adsorption HILIC mechanisms. The columns also exhibited satisfactory performance in the separation of these target compounds, showing good chromatographic behaviour after two months of continued use. These composite monolithic columns were also successfully applied to the extraction of a tryptic digest of β-casein.

Rates of adherence to bone health guidelines for women with breast cancer treated with anti-estrogen therapy.

7051 Background: Long-term use of aromatase inhibitor (AI) therapy has been shown to decrease bone mineral density (BMD) and is associated with at least twice the fracture risk when compared to an age-matched healthy population. AI’s are a common treatment in hormone receptor-positive breast cancer for post-menopausal women. Similarly, tamoxifen has been shown to decrease BMD in premenopausal women. As a result, the National Comprehensive Cancer Network (NCCN) recommends BMD screening for women being treated with anti-estrogen therapy (AET), typically via Dual-energy X-ray absorptiometry (DEXA) scan. Previous studies have shown poor adherence to BMD screening with AI therapy, but no known study has evaluated compliance with tamoxifen therapy. Methods: We evaluated a retrospective cohort (December 2015 – July 2019) of all women with a breast cancer diagnosis initiating AET using data from the electronic health records of patients throughout a rural integrated health system. We assessed non-adherence to baseline and annual BMD screening using descriptive statistics along with preliminary data regarding fractures associated with AET therapy. Results: A total of 3,693 health records of women with a breast cancer diagnosis and documented prescription for AET were evaluated. In the year before AET initiation, 16% of women received BMD screening. Overall, 1,189 women treated with AET had a DEXA scan ordered at any point after drug initiation: 37% for AI’s and 12% for tamoxifen. Of those treated with AI, 84% had no DEXA ordered within 12 months of starting drug after a minimum of 9 months of continuous use; this value was 96% for tamoxifen use. Patients complied with the ordered DEXA scan within the first year 81% of the time. Repeat DEXA scans were ordered 34% of the time, and patient compliance decreased to 55%. There was no significant difference in the number of patient co-morbidities between patients who did and did not have a DEXA scan ordered. After starting an AI, 131 fractures were documented; 44% occurred within the first year following starting drug treatment with an average of 5 months from drug start to diagnosis. Conclusions: A significant proportion of breast cancer patients treated with AET did not receive guideline-recommended BMD screening. These findings should raise awareness of the importance of BMD screening by responsible providers, including oncologists, primary care physicians, care managers and insurance companies in order to decrease avoidable morbidity.

The Effect of Long-Term Second-Generation Antipsychotics Use on the Metabolic Syndrome Parameters in Jordanian Population.

Objectives: The aim of this study was to determine the incidence of metabolic syndrome in patients treated with second-generation antipsychotics (SGAs). Methods: In this retrospective study, we reviewed patients’ electronic medical records (EMRs) of all patients who received one SGA for at least six months, excluding patients who were taking other medications that are associated with significant effect on metabolic syndrome. Relevant clinical information was collected prior to starting the SGA and after six months of continuous use of the same SGA. Results: A total of 91 patients were included in the study. The majority of patients (72%) were diagnosed with schizophrenia. After six months of taking the SGA, 44% of patients experienced elevated systolic pressure, 54.9% had elevated triglyceride, and 31.9% had impaired glucose levels (p value < 0.05). Prior to initiating SGA therapy, 14.3% of patients had metabolic syndrome, while 37.4% had metabolic syndrome after six months of therapy, and it was more prominent in males compared to female patients (p value < 0.05). Conclusion: This study found a strong correlation between SGA use and the appearance of metabolic alterations, such as weight gain, glucose intolerance, and increased triglyceride levels. These findings highlight the importance of assessing metabolic deregulations to minimize SGA associated metabolic abnormalities.

Prediction of Complications, Readmission, and Revision Surgery Based on Duration of Preoperative Opioid Use: Analysis of Major Joint Replacement and Lumbar Fusion.

Preoperative opioid use results in adverse outcomes and higher costs after elective surgery. However, duration thresholds for higher risk are not entirely known. Therefore, the purpose of our study was to determine the number and duration of preoperative opioid prescriptions in order to estimate the risk of postoperative adverse events after major joint replacement and lumbar fusion. National insurance claims data (2007 to September 30, 2015) were used to identify primary total knee arthroplasties (TKAs), total hip arthroplasties (THAs), and 1 or 2-level posterior lumbar fusions (PLFs) performed for degenerative disease. The effect of preoperative opioid burden (naive, ≤3 months, >3 to 6 months, >6 months but stopped 3 months before surgery, and >6 months of continuous use) on the risks of various adverse outcomes was studied using Cox proportional hazards analysis with adjustment for demographic and clinical covariates. A total of 58,082 patients stratified into 3 cohorts of 32,667 with TKA, 14,734 with THA, and 10,681 with 1 or 2-level PLF were included for this analysis. A duration of preoperative opioids of >3 months was associated with a higher risk of 90-day emergency department (ED) visits for all causes and readmission after TKA. Preoperative opioid prescription for >6 months was associated with a higher risk of all-cause and pain-related ED visits, wound dehiscence/infection, and hospital readmission within 90 days as well as revision surgery within 1 year after TKA, THA, and PLF. Stopping the opioid prescription 3 months preoperatively for chronic users resulted in a significant reduction in the risk of adverse outcomes, with the greatest impact seen after THA and PLF. Patients with a preoperative opioid prescription for up to 3 months before a major arthroplasty or a 1 or 2-level lumbar fusion had a similar risk of adverse outcomes as opioid-naive patients. While >6 months of opioid use was associated with a higher risk of adverse outcomes, a 3-month prescription-free period before the surgery appeared to mitigate this risk for chronic users. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Qualitative analysis of patient responses to the ABCD FreeStyle Libre audit questionnaire

AbstractThe Abbott FreeStyle Libre flash glucose monitoring system is a novel sensor‐based, factory‐calibrated device that allows individuals with diabetes to monitor their interstitial glucose levels, capture up to 8 hours of interstitial glucose data, and predict future changes in interstitial glucose by scanning a temporary implantable glucose sensor with a reader device or compatible mobile phone.The study aim was to determine whether use of a flash glucose monitoring system had an impact on quality of life and to explore why this was the case.Raw data were collected as part of a brief semi‐structured interview supported by the ABCD FreeStyle Libre Follow‐Up Visit Data Collection form. Data were collected pragmatically at outpatient clinic follow‐up visits, and the first 40 patients to complete six months of continuous use were included in the study.Feedback on use of the device was overwhelmingly (although not unanimously) positive. A number of basic themes were identified independently by the investigators, which were then grouped into four organising themes: Contrast with capillary blood glucose monitoring; Impact on hypoglycaemia experience; Glycaemic control and complications; and Improved wellbeing and quality of life. These themes are analysed and illustrated in the article. Copyright © 2019 John Wiley &amp; Sons.

Bridging the digital divide among low income urban communities. Leveraging use of Community Technology Centers

To fully leverage the availability of the internet services in Kenya, all the citizens need to be able to access and use the internet and related services. The availability of 4G networks, cyber cafés and fiber connectivity in most residential areas of Nairobi has allowed many Nairobi residents to be part of its information-based society. But, as with the other existing social inequalities in Nairobi, many people residing in the city’s low-income areas lack access to the internet. This has a negative impact on the residents’ prospects as the governments and businesses are increasingly delivering their services online. Using a pre-tested questionnaire, data were collected from five hundred and fifty respondents on their internet access and digital literacy skills among the residents of the Mathare Slum. From the survey, the study found existence of limited digital literacy skills and lack of internet access among the residents of the Mathare Slum. The study then used the Community Technology Centers (CTCs) intervention approach to narrowing the digital divide by setting up a CTC in the Mathare Slum to offer free community internet access and digital literacy skills training. Eight cohorts, each of eighteen residents, were offered free digital literacy training for five weeks and free unlimited internet access for four months. The study then evaluated the trainees’ internet usage continuance intentions after four months of continued use of the internet at the CTC. The results indicate that perceived enjoyment, perceived usefulness, internet self-efficacy, and confirmation of expectations all significantly influence the participants’ satisfaction with use of the internet. The results also show that continuance intentions of the participants from low income household to continue using internet beyond the CTC can be predicted by perceived service cost, satisfaction, internet self-efficacy and perceived usefulness. The study demonstrates the effectiveness of CTCs as an intervention approach and a replicable model that can be used to bridge the urban digital divide among low income urban communities for the development of an all-inclusive information-based society. Implications and recommendations for policy, practice and research are provided.

Changes in body composition in women using long-acting reversible contraception

ObjectiveUsers of hormonal long-acting reversible contraception (LARC) report weight gain as a side effect, but few studies have assessed body composition change among LARC users. We evaluated weight and body composition of healthy women using the levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (copper IUD) or etonogestrel implant (ENG implant). We hypothesized that weight gain and body composition over 12 months would not differ between copper IUD, LNG-IUS and ENG implant users. Study designWe performed a prospective cohort study of a subgroup of women enrolled in the Contraceptive CHOICE Project who initiated the LNG-IUS, copper IUD or ENG implant. Inclusion criteria included lack of metabolic and eating disorders or change in body weight of more than 5% in the 6 months before enrollment. We measured changes in weight and body composition (body fat percentage, total body fat mass, total lean mass and total body mass) in women who continued their method for 12 months. ResultsWe analyzed data from 149 participants: 85 LNG-IUS users, 31 copper IUD users and 33 ENG implant users. The mean age was 25.9 years, 56.4% were White, 82.5% had some college education and 67.6% were nulliparous. Although lean body mass increased over 12 months in LNG-IUS and copper IUD users but not in ENG implant users, changes in body weight and body composition did not differ between the groups. In the adjusted model, Black race was associated with change in total body mass (p<.05). ConclusionsAmong those who continued the method for 12 months, changes in body weight and composition did not differ between copper IUD, LNG-IUS and ENG implant users. Implications statementChanges in body weight and composition over 12 months did not differ between copper IUD users and LNG-IUS and ENG implant users among those with 12 months of continuous use.

Long-term effects of lateral wedge orthotics on hip and ankle joint space widths

BackgroundLateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use. MethodsWe prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up. Findings45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month. InterpretationWe found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).