Search

Purpose: To evaluate the clinical efficacy and patient satisfaction rates of low-intensity extracorporeal shockwave therapy LIESWT) in men with vasculogenic erectile dysfunction (ED) using Duolith SD1 machine. Materials and Methods: This prospective, randomized, double-blinded clinical trial included 60 men who were randomly assigned to LIESWT (n=30, active group) or placebo (n=30) over 6 weeks. Patient demographics, change in International Index of Erectile Function (IIEF)-5, Erection Hardness Score (EHS) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores, and an overall satisfaction score (on a 5-point scale), were recorded. All patients were reviewed at 1, 3, and 6 months after completion of therapy. Results: There were 21 (70%) patients in the LIESWT group and 3 (10%) patients in the placebo group who had a 5-point or greater increase in IIEF-5 score (p=0.018). At 6-month study period, the mean IIEF-5 score was 18.8 (standard deviation [SD], 3.8) in the LIESWT group versus 14.8 (SD, 3.6) in the placebo group, difference in means between groups was 4.0 (95% confidence interval, 2.1–5.9; p

Abstract This paper proposes a novel approach for generating 3-dimensional complex geological facies models based on deep generative models. It can reproduce a wide range of conceptual geological models while possessing the flexibility necessary to honor constraints such as well data. Compared with existing geostatistics-based modeling methods, our approach produces realistic subsurface facies architecture in 3D using a state-of-the-art deep learning method called generative adversarial networks (GANs). GANs couple a generator with a discriminator, and each uses a deep convolutional neural network. The networks are trained in an adversarial manner until the generator can create “fake” images that the discriminator cannot distinguish from “real” images. We extend the original GAN approach to 3D geological modeling at the reservoir scale. The GANs are trained using a library of 3D facies models. Once the GANs have been trained, they can generate a variety of geologically realistic facies models constrained by well data interpretations. This geomodelling approach using GANs has been tested on models of both complex fluvial depositional systems and carbonate reservoirs that exhibit progradational and aggradational trends. The results demonstrate that this deep learning-driven modeling approach can capture more realistic facies architectures and associations than existing geostatistical modeling methods, which often fail to reproduce heterogeneous nonstationary sedimentary facies with apparent depositional trend.

Abstract Background Beta-blockers are commonly prescribed for patients with cardiovascular disease. Providers have been wary of treating chronic obstructive pulmonary disease (COPD) patients with beta-blockers due to concern for bronchospasm, but retrospective studies have shown that cardio-selective beta-blockers are safe in COPD and possibly beneficial. However, these benefits may reflect symptom improvements due to the cardiac effects of the medication. The purpose of this study is to evaluate associations between beta-blocker use and both exacerbation rates and longitudinal measures of lung function in two well-characterized COPD cohorts. Methods We retrospectively analyzed 1219 participants with over 180 days of follow up from the STATCOPE trial, which excluded most cardiac comorbidities, and from the placebo arm of the MACRO trial. Primary endpoints were exacerbation rates per person-year and change in spirometry over time in association with beta blocker use. Results Overall 13.9% (170/1219) of participants reported taking beta-blockers at enrollment. We found no statistically significant differences in exacerbation rates with respect to beta-blocker use regardless of the prevalence of cardiac comorbidities. In the MACRO cohort, patients taking beta-blockers had an exacerbation rate of 1.72/person-year versus a rate of 1.71/person-year in patients not taking beta-blockers. In the STATCOPE cohort, patients taking beta-blockers had an exacerbation rate of 1.14/person-year. Patients without beta-blockers had an exacerbation rate of 1.34/person-year. We found no detrimental effect of beta blockers with respect to change in lung function over time. Conclusion We found no evidence that beta-blocker use was unsafe or associated with worse pulmonary outcomes in study participants with moderate to severe COPD.

QuestionCan a multifaceted statewide communications campaign motivate behavior change in low-income Colorado families to limit children’s fruit juice consumption and increase children’s consumption of tap water to prevent tooth decay?PurposeCaries is the most common chronic disease of childhood, affecting 40% of kindergartners and 55% of third graders in Colorado. Frequent consumption of 100% fruit juice is linked to childhood caries. The purpose of this campaign, “Cavities Get Around,” was to motivate families to limit children’s fruit juice consumption and increase consumption of tap water to protect baby teeth from caries, while also building public will for children’s oral health.MethodsThe campaign included targeted media, promotores/organizers, and family education. We focused on fruit juice because audience research showed many families view fruit juice as healthy, and it is also a common beverage among young children up to age of 6 years. We also focused on low-socioeconomic status families because data show higher childhood tooth decay rates in this population. To evaluate progress, we conducted identical pre- and post-surveys, each of 600 random low-income parents contacted by landline, mobile telephone, and Internet, allowing for comparative data.ResultsSignificant progress was achieved compared to 2014 baseline results. Findings from a November 2015 statewide survey of parents included the following: (1) 22-point increase from 2014 in percentage of children regularly drinking tap water (from 41 to 63%). (2) 29-point decrease from 2014 in percentage of respondents who considered fruit juice consumption important to their child’s health and nutritional needs (from 72 to 43%). (3) 19-point reduction in fruit juice consumption among young children (from 66% in 2014 to 47% in 2015). (4) 6-point reduction in percentage of parents considering baby teeth “less important” than adult teeth (from 21% in 2014 to 15% in 2015). The campaign also played a role in new state rules prohibiting childcare centers from serving sugar-sweetened beverages and capping 100% juice to twice per week.ConclusionThe campaign development, strategies, and evaluation results are instructive for others working on health promotion, childhood nutrition, and education interventions.

This paper presents a survey of methods and techniques developed for the solution of the continuous gas-lift optimization problem over the last two decades. These range from isolated single-well analysis all the way to real-time multivariate optimization schemes encompassing all wells in a field. While some methods are clearly limited due to their neglect of treating the effects of inter-dependent wells with common flow lines, other methods are limited due to the efficacy and quality of the solution obtained when dealing with large-scale networks comprising hundreds of difficult to produce wells. The aim of this paper is to provide an insight into the approaches developed and to highlight the challenges that remain.

The prefrontal cortex (PFC) is a brain region that is critically involved in cognitive function and inhibitory control of behavior, and adolescence represents an important period of continued PFC development that parallels the maturation of these functions. Evidence suggests that this period of continued development of the PFC may render it especially vulnerable to environmental insults that impact PFC function in adulthood. Experimentation with alcohol typically begins during adolescence when binge-like consumption of large quantities is common. In the present study, we investigated the effects of repeated cycles of adolescent intermittent ethanol (AIE) exposure (postnatal days 28-42) by vapor inhalation on different aspects of executive functioning in the adult rat. In an operant set-shifting task, AIE-exposed rats exhibited deficits in their ability to shift their response strategy when the rules of the task changed, indicating reduced behavioral flexibility. There were no differences in progressive ratio response for the reinforcer suggesting that AIE did not alter reinforcer motivation. Examination of performance on the elevated plus maze under conditions designed to minimize stress revealed that AIE exposure enhanced the number of entries into the open arms, which may reflect either reduced anxiety and/or disinhibition of exploratory-like behavior. In rats that trained to self-administer ethanol in an operant paradigm, AIE increased resistance to extinction of ethanol-seeking behavior. This resistance to extinction was reversed by positive allosteric modulation of mGluR5 during extinction training, an effect that is thought to reflect promotion of extinction learning mechanisms within the medial PFC. Consistent with this, CDPPB was also observed to reverse the deficits in behavioral flexibility. Finally, diffusion tensor imaging with multivariate analysis of 32 brain areas revealed that while there were no differences in the total brain volume, the volume of a subgroup of regions (hippocampus, thalamus, dorsal striatum, neocortex, and hypothalamus) were significantly different in AIE-exposed adults compared with litter-matched Control rats. Taken together, these findings demonstrate that binge-like exposure to alcohol during early to middle adolescence results in deficits in PFC-mediated behavioral control in adulthood. [ABSTRACT FROM AUTHOR]

AbstractObjective:To explore whether obesity alters the risk, impairment and response to treatment in African Americans with asthma.Methods:The data used for this secondary analysis are from a 1-year study in African American subjects comparing fluticasone propionate/salmeterol 100/50µg combination (FSC) and fluticasone propionate 100µg (FP). Subjects were retrospectively stratified by body mass index (BMI) <20 [underweight], 20–24.9 [normal weight], 25–29.9 [overweight], 30–34.9 [obese I], 35–39.9 [obese II], and 40 [obese III] kg/m2. Outcomes studied included impairment domains: FEV1, morning and evening peak expiratory flow (AM and PM PEF), daily albuterol use, daily symptom scores and future risk domain: exacerbations.Clinical trial registration:www.clinicaltrials.gov; NCT00102765Results:There were 475 subjects evenly distributed between FSC and FP by baseline parameters. There were 207 subjects with a BMI 30, including 70 subjects with a BMI 40. Baseline BMI 40 was associated with numerically lower baseline AM and PM PEF. There was an attenuation of response to both treatments for only PM PEF (p<0.05). By contrast, subjects with lower degrees of obesity or overweight did not differ from those with normal weight. The total population exacerbation rate was 2-fold greater in obese III subjects (39) compared with subjects in other BMI categories (16–21) (p<0.05). A potential study limitation is the retrospective analysis of existing data.Discussion:Response to treatment was attenuated for PM PEF for subjects with BMI 40 and was also associated with an increased rate of asthma exacerbations. [ABSTRACT FROM AUTHOR]

Objective: This long-term prospective study was conducted in African Americans with persistent asthma to examine the safety and effectiveness of the combination of the inhaled corticosteroid, fluticasone propionate (FP), and the long-acting beta-agonist, salmeterol, compared with FP alone.Research and design methods: This was a randomized, double-blind, parallel group, multi-center trial in adolescent and adult subjects ≥12 years of age symptomatic on a low dose of an inhaled corticosteroid (ICS). The study consisted of a 2-week screening period on low dose ICS; a 4-week open-label FP 250 mcg twice daily (BID) run-in; a 52-week double-blind period (FP/salmeterol [FSC] 100/50 mcg [n=239] or FP 100 mcg [n=236] BID), and a 4-week FP 250 mcg BID run-out period. Annualized exacerbation rate was the primary outcome for comparing the two treatments. Other measures of asthma control included peak expiratory flow, asthma symptoms, and albuterol use. Safety was assessed through adverse events.Results: Exacerbation rates were not significantly different in those treated with FSC 100/50 mcg (0.449 per year) compared with FP 100 mcg (0.529 per year, p=0.169). When the per-protocol analysis was applied, the rates were 0.465 and 0.769 per year for FSC 100/50 mcg and FP 100 mcg, respectively. Treatment with FSC 100/50 mcg provided statistically greater improvements in lung function measures and nighttime awakenings (p≤0.050) and demonstrated numerically lower daily symptoms (p=0.216) and albuterol use (p=0.122). Two subjects treated with FSC 100/50 mcg were hospitalized for an asthma exacerbation compared to three treated with FP 100 mcg. The overall incidence of adverse effects during double-blind treatment was similar between the FSC 100/50 mcg and FP 100 mcg treatment groups (61% and 68%, respectively). Frequent study visits were required of subjects during this long-term study, and it remains unknown whether this intervention may affect generalizability.Conclusion: In this large, prospective study among African Americans with asthma, the addition of salmeterol to FP resulted in a similar low rate of exacerbations and improved other markers of asthma control. Both FSC 100/50 mcg and FP 100 mcg were well-tolerated, and the overall safety-profiles were similar over 1 year of treatment. [ABSTRACT FROM AUTHOR]