Search

Your search keyword '"MULTIPLE COURSES"' showing total 23 results
Start Over Descriptor "MULTIPLE COURSES"
23 results on '"MULTIPLE COURSES"'

1. Necessities for English Majors to Take Multiple Courses

Author

Zhang, Heming, Striełkowski, Wadim, Editor-in-Chief, Black, Jessica M., Series Editor, Butterfield, Stephen A., Series Editor, Chang, Chi-Cheng, Series Editor, Cheng, Jiuqing, Series Editor, Dumanig, Francisco Perlas, Series Editor, Al-Mabuk, Radhi, Series Editor, Scheper-Hughes, Nancy, Series Editor, Urban, Mathias, Series Editor, Webb, Stephen, Series Editor, Li, Houlin, editor, and Nie, Zhenxin, editor

Published
2024
Full Text
View/download PDF

2. Multiple courses of steroid pulse therapy are required in treating acquired idiopathic generalized anhidrosis patients with a large anhidrotic area: A retrospective study of 28 cases.

Author

Imafuku, Keisuke, Yanagi, Teruki, Yoshimoto, Norihiro, Miyazawa, Hajime, Iwata, Hiroaki, and Ujiie, Hideyuki

Subjects
*STEROID drugs, *UNIVARIATE analysis, *RETROSPECTIVE studies
Abstract

Patients with acquired idiopathic generalized anhidrosis (AIGA) demonstrate a sudden loss of sweating function without neurological or endocrine abnormalities. The main treatment is steroid pulse therapy. However, the number of courses required for improvement has been unclear. This study aims to clarify the factors associated with AIGA disease severity and with AIGA patients' responses to steroid pulse therapy. We retrospectively analysed the clinical information of 28 patients with AIGA in our department from the last 10 years. Univariate analysis revealed that patients with a large anhidrotic area need multiple courses of steroid pulse therapy. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

3. Long-term cancer survivors treated with multiple courses of repeat radiation therapy

Author

Sebastian M. Christ, Maiwand Ahmadsei, Lotte Wilke, Anja Kühnis, Matea Pavic, Stephanie Tanadini-Lang, and Matthias Guckenberger

Subjects
Radiation therapy, Repeat irradiation, Multiple courses, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Introduction and background Through recent advances in cancer care, the number of long-term survivors has continuously increased. As a result, repetitive use of local radiotherapy for curative or palliative indications might have increased as well. This analysis aims to describe patterns of care and outcome of patients treated with multiple courses of repeat radiotherapy. Materials and methods All patients treated with radiotherapy between 2011 and 2019 at our department of Radiation Oncology were included into this analysis. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. Demographics, cancer and treatment characteristics and overall survival of patients having undergone multiple radiotherapy courses (minimum n = 5) were evaluated. Results The proportion of cancer patients treated with a minimum five courses of radiotherapy increased continuously from 0.9% in 2011 to 6.5% in 2019. In the 112 patients treated with a minimum of five radiotherapy courses, the primary tumor was lung in 41.9% (n = 47), malignant melanoma in 8.9% (n = 10) and breast in 8.0% (n = 9) of cases. A median interval of 3 years (maximum 8 years) elapsed between the first and the last radiotherapy course. The maximum number of courses in a single patient were n = 10. Treatment intent was curative or palliative in 46.4% and 53.6% for the first radiotherapy, respectively. The proportion of curative intent decreased to 11.6% at the 5th, and the last radiotherapy course was following a palliative intent in all patients. Five-year overall survival measured from the 1st radiotherapy course was 32.7%. Median overall survival was 3.3, 2.4, 1.3, and 0.6 years when measured from the 1st, the 1st palliative, the 5th and last course of radiotherapy, respectively. Discussion and conclusion A continuously increasing number of patients is treated with multiple courses of radiotherapy throughout their long-term cancer survivorship.

Published
2021
Full Text
View/download PDF

4. Long-term cancer survivors treated with multiple courses of repeat radiation therapy.

Author

Christ, Sebastian M., Ahmadsei, Maiwand, Wilke, Lotte, Kühnis, Anja, Pavic, Matea, Tanadini-Lang, Stephanie, and Guckenberger, Matthias

Subjects
*RADIOTHERAPY, *CURRICULUM, *CANCER survivors, *OVERALL survival, *SURVIVAL rate, *MELANOMA
Abstract

Introduction and Background: Through recent advances in cancer care, the number of long-term survivors has continuously increased. As a result, repetitive use of local radiotherapy for curative or palliative indications might have increased as well. This analysis aims to describe patterns of care and outcome of patients treated with multiple courses of repeat radiotherapy.Materials and Methods: All patients treated with radiotherapy between 2011 and 2019 at our department of Radiation Oncology were included into this analysis. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. Demographics, cancer and treatment characteristics and overall survival of patients having undergone multiple radiotherapy courses (minimum n = 5) were evaluated.Results: The proportion of cancer patients treated with a minimum five courses of radiotherapy increased continuously from 0.9% in 2011 to 6.5% in 2019. In the 112 patients treated with a minimum of five radiotherapy courses, the primary tumor was lung in 41.9% (n = 47), malignant melanoma in 8.9% (n = 10) and breast in 8.0% (n = 9) of cases. A median interval of 3 years (maximum 8 years) elapsed between the first and the last radiotherapy course. The maximum number of courses in a single patient were n = 10. Treatment intent was curative or palliative in 46.4% and 53.6% for the first radiotherapy, respectively. The proportion of curative intent decreased to 11.6% at the 5th, and the last radiotherapy course was following a palliative intent in all patients. Five-year overall survival measured from the 1st radiotherapy course was 32.7%. Median overall survival was 3.3, 2.4, 1.3, and 0.6 years when measured from the 1st, the 1st palliative, the 5th and last course of radiotherapy, respectively.Discussion and Conclusion: A continuously increasing number of patients is treated with multiple courses of radiotherapy throughout their long-term cancer survivorship. [ABSTRACT FROM AUTHOR]

Published
2021
Full Text
View/download PDF

5. Cytokine profiles and virological markers highlight distinctive immune statuses, and effectivenesses and limitations of NAs across different courses of chronic HBV infection.

Author

Xiao, Lixin, Tang, Kang, Fu, Ting, Yuan, Xiaojie, Seery, Samuel, Zhang, Weilu, Ji, Zhaohua, He, Zhen, Yang, Yan, Zhang, Wenhua, Jia, Wenling, Liang, Chunhui, Tang, Haitao, Wang, Fengmei, Ye, Yancheng, Chen, Lihua, and Shao, Zhongjun

Subjects
*HEPATITIS B, *TUMOR necrosis factor receptors, *IMMUNITY, *CHRONIC hepatitis B, *CHEMOKINES, *CYTOKINES
Abstract

• Host immune changes at different stages of chronic HBV infection were systematically summarized and analyzed from the perspective of cytokines. • Luminex multiplex analysis was used to detect serum cytokines of patients. • The combination of IL-6, IL-8, CXCL9 and CXCL13 was closely correlated with HCC during chronic HBV infection. • Current antiviral therapy (NAs) was beneficial for killing the virus but had no significant effect on immune recovery. The characteristics of cytokine/chemokine(CK) profiles across different courses of chronic hepatitis B virus infection and the effects of NAs antiviral therapy on cytokine profiles remain unclear. This report provides evidence from 383 patients with chronic HBV infection. The Luminex multiple cytokine detection technology was used to detect CK profiles. The predictive power of CKs across course of disease was assessedusing univariate analyses and with receiver operating characteristic (ROC) curves. Compared to healthy control (HC), expression levels of interleukin 6 (IL)-6, IL-8, IL-21, matrix metalloproteinases (MMP)-2 and tumor necrosis factor receptor (TNFR)-1 showed a significant increasing trend during chronic HBV infection. IL-23 and IL-33 increased respectively in chronic hepatitis B patients (CHB). interferon (IFN)-gamma and TNF-α changed significantly only in liver cirrhosis (LC) patients. Whereas, myeloid-related markers decreased dramatically in those with hepatocellular carcinoma (HCC). The ROC result suggests that combining IL-6, IL-8, CXCL9 and CXCL13 into a nomogram has closely correlation with HCC during chronic HBV infection. In addition, nucleotide analogues (NAs) antiviral treatments are capable of recoveringnormal liver functions and significantly reducing the viral loads, however, they seem to have a limited effect in changing CKs, especially specific antiviral factors. The differential CK and virological markers may serve as potential indicators of distinct immune statuses in chronic HBV infection. They also underscore the varying efficacy and limitations of NAs antiviral therapies. This next step would to break new ground in the optimization of current anti-HBV treatment programs although this requires further research. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

6. Long-term cancer survivors treated with multiple courses of repeat radiation therapy

Author

Matea Pavic, Sebastian M. Christ, Stephanie Tanadini-Lang, Anja Kühnis, Matthias Guckenberger, Maiwand Ahmadsei, L. Wilke, University of Zurich, and Christ, Sebastian M

Subjects
Adult, Male, medicine.medical_specialty, Multiple courses, medicine.medical_treatment, R895-920, Treatment intent, 610 Medicine & health, Re-Irradiation, Medical physics. Medical radiology. Nuclear medicine, Cancer Survivors, Neoplasms, Internal medicine, Radiation oncology, medicine, 2741 Radiology, Nuclear Medicine and Imaging, Humans, Radiology, Nuclear Medicine and imaging, RC254-282, Aged, Retrospective Studies, Aged, 80 and over, Patterns of care, Long-Term Cancer Survivors, business.industry, Research, Melanoma, Palliative Care, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Cancer, Middle Aged, Prognosis, medicine.disease, 10044 Clinic for Radiation Oncology, Primary tumor, Survival Rate, Radiation therapy, Repeat irradiation, Oncology, 2730 Oncology, Female, business
Abstract

Introduction and background Through recent advances in cancer care, the number of long-term survivors has continuously increased. As a result, repetitive use of local radiotherapy for curative or palliative indications might have increased as well. This analysis aims to describe patterns of care and outcome of patients treated with multiple courses of repeat radiotherapy. Materials and methods All patients treated with radiotherapy between 2011 and 2019 at our department of Radiation Oncology were included into this analysis. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. Demographics, cancer and treatment characteristics and overall survival of patients having undergone multiple radiotherapy courses (minimum n = 5) were evaluated. Results The proportion of cancer patients treated with a minimum five courses of radiotherapy increased continuously from 0.9% in 2011 to 6.5% in 2019. In the 112 patients treated with a minimum of five radiotherapy courses, the primary tumor was lung in 41.9% (n = 47), malignant melanoma in 8.9% (n = 10) and breast in 8.0% (n = 9) of cases. A median interval of 3 years (maximum 8 years) elapsed between the first and the last radiotherapy course. The maximum number of courses in a single patient were n = 10. Treatment intent was curative or palliative in 46.4% and 53.6% for the first radiotherapy, respectively. The proportion of curative intent decreased to 11.6% at the 5th, and the last radiotherapy course was following a palliative intent in all patients. Five-year overall survival measured from the 1st radiotherapy course was 32.7%. Median overall survival was 3.3, 2.4, 1.3, and 0.6 years when measured from the 1st, the 1st palliative, the 5th and last course of radiotherapy, respectively. Discussion and conclusion A continuously increasing number of patients is treated with multiple courses of radiotherapy throughout their long-term cancer survivorship.

Published
2021

7. Erratum to: Blogging Activities in Higher Education: Comparing Learning Scenarios in Multiple Course Experiences

Author

Popescu, Elvira, Kubincová, Zuzana, Homola, Martin, Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Li, Frederick W.B., editor, Klamma, Ralf, editor, Laanpere, Mart, editor, Zhang, Jun, editor, Manjón, Baltasar Fernández, editor, and Lau, Rynson W.H., editor

Published
2015
Full Text
View/download PDF

8. Antenatal corticosteroids and outcomes in gastroschisis: A multicenter retrospective cohort study

Author

Carnaghan, Helen, James, Catherine P, Charlesworth, Paul B, Ghionzoli, Marco, Pereira, Susana, Elkhouli, Mohamed, Baud, David, De Coppi, Paolo, Ryan, Greg, Shah, Prakesh S, Davenport, Mark, David, Anna L, Pierro, Agostino, Eaton, Simon, Lapidus-Krol, Eveline, Cross, Kate MK, Kiely, Edward, Patel, Shailesh, Desai, Ashish, Nicolaides, Kypros, Curry, Joseph, and Ade-Ajayi, Niyi

Subjects
0301 basic medicine, Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, PRETERM BIRTH, Gestational Age, 030105 genetics & heredity, Antenatal steroid, Cohort Studies, DELIVERY, 03 medical and health sciences, AGE, 0302 clinical medicine, Enteral Nutrition, Adrenal Cortex Hormones, Pregnancy, MANAGEMENT, Medicine, Humans, MULTIPLE COURSES, Genetics (clinical), Retrospective Studies, Genetics & Heredity, Gastroschisis, Fetus, Science & Technology, 030219 obstetrics & reproductive medicine, business.industry, Proportional hazards model, Hazard ratio, Infant, Newborn, Pregnancy Outcome, Obstetrics & Gynecology, Obstetrics and Gynecology, Retrospective cohort study, Prenatal Care, Length of Stay, medicine.disease, Delivery, Obstetric, Prognosis, Treatment Outcome, Secondary Outcome Measure, Female, business, Life Sciences & Biomedicine, Cohort study
Abstract

OBJECTIVE: In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants. METHODS: A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression. RESULTS: Of 500 patients included in the study, 69 (GA at birth 34 [25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 [31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 [95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 [95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA [95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds. CONCLUSION: Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay. ispartof: PRENATAL DIAGNOSIS vol:40 issue:8 pages:991-997 ispartof: location:England status: published

Published
2019

9. Low-dose betamethasone-acetate for fetal lung maturation in preterm sheep

Subjects
PHARMACOKINETICS, ANTENATAL CORTICOSTEROIDS, BORN, NEONATAL-MORTALITY, BIRTH, GLUCOCORTICOID TREATMENT, prematurity, fetal lung maturation, RANDOMIZED CONTROLLED-TRIAL, betamethasone, TERM, PREGNANCY, RESPIRATORY-DISTRESS, TRIAL, GESTATIONAL-AGE, MULTIPLE COURSES
Abstract

BACKGROUND: Antenatal steroids are standard of care for women who are at risk of preterm delivery; however, antenatal steroid dosing and formulation have not been evaluated adequately. The standard clinical 2-dose treatment with betamethasone-acetate+betamethasone-phosphate is more effective than 2 doses of betamethasone-phosphate for the induction of lung maturation in preterm fetal sheep. We hypothesized that the slowly released betamethasone-acetate component induces similar lung maturation to betamethasone-phosphate+betamethasone-acetate with decreased dose and fetal exposure. OBJECTIVE: The purpose of this study was to investigate pharmacokinetics and fetal lung maturation of antenatal betamethasone-acetate in preterm fetal sheep. STUDY DESIGN: Groups of 10 singleton-pregnant ewes received 1 or 2 intramuscular doses 24 hours apart of 0.25 mg/kg/dose of betamethasone-phosphate+betamethasone-acetate (the standard of care dose) or 1 intramuscular dose of 0.5 mg/kg, 0.25 mg/kg, or 0.125 mg/kg of betamethasone-acetate. Fetuses were delivered 48 hours after the first injection at 122 days of gestation (80% of term) and ventilated for 30 minutes, with ventilator settings, compliance, vital signs, and blood gas measurements recorded every 10 minutes. After ventilation, we measured static lung pressure-volume curves and sampled the lungs for messenger RNA measurements. Other groups of pregnant ewes and fetuses were catheterized and treated with intramuscular injections of betamethasone-phosphate 0.125 mg/kg, betamethasone-acetate 0.125 mg/kg, or betamethasone-acetate 0.5 mg/kg. Maternal and fetal betamethasone concentrations in plasma were measured for 24 hours. RESULTS: All betamethasone-treated groups had increased messenger RNA expression of surfactant proteins A, B, and C, ATP-binding cassette subfamily A member 3, and aquaporin-5 compared with control animals. Treatment with 1 dose of intramuscular betamethasone-acetate 0.125mg/kg improved dynamic and static lung compliance, gas exchange, and ventilation efficiency similarly to the standard treatment of 2 doses of 0.25 m/kg of betamethasone-acetate+betamethasone-phosphate. Betamethasone-acetate 0.125 mg/kg resulted in lower maternal and fetal peak plasma concentrations and decreased fetal exposure to betamethasone compared with betamethasone-phosphate 0.125 mg/kg. CONCLUSION: A single dose of betamethasone-acetate results in similar fetal lung maturation as the 2-dose clinical formulation of betamethasone-phosphatethornbetamethasone-acetate with decreased fetal exposure to betamethasone. A lower dose of betamethasone-acetate may be an effective alternative to induce fetal lung maturation with less risk to the fetus.

Published
2018

10. Repeated courses of ibuprofen are effective in closure of a patent ductus arteriosus.

Author

Lugt, N., Lopriore, Enrico, Bökenkamp, Regina, Smits-Wintjens, Vivianne, Steggerda, Sylke, and Walther, Frans

Subjects
*IBUPROFEN, *ANALGESICS, *PATENT ductus arteriosus, *PREMATURE infant diseases, *DRUG side effects, *THERAPEUTICS
Abstract

Patent ductus arteriosus (PDA) is a frequent complication in preterm infants. Ibuprofen and indomethacin (both COX inhibitors) are used for pharmacological closure of PDA. In most centers, a failed second course of COX inhibitors is followed by surgical closure. Our aim was to estimate the closure rate of clinically significant PDA after second and third courses of ibuprofen and record possible side effects. A study population, consisting of 164 preterm infants (<32 weeks' gestational age) with PDA admitted at our tertiary care center between November 2005 and September 2011, was retrospectively analyzed. Primary outcome was the closure rate after repeated courses of ibuprofen. The closure rate was similar after the first (109/164), second (24/43), and third (6/11) course of ibuprofen ( X = 2.1, p = 0.350). Late start of the first course of ibuprofen was a predictive factor for increased need of a second course ( X = 4.4, p = 0.036). No additional side effects of multiple courses of ibuprofen were detected. In conclusion, repeated courses of ibuprofen are an effective and safe alternative for surgical closure and should be considered after failure of the first course of ibuprofen. [ABSTRACT FROM AUTHOR]

Published
2012
Full Text
View/download PDF

11. Multiple courses of pulse corticosteroid therapy for alopecia areata.

Author

Yoshimasu, Takashi, Kanazawa, Nobuo, Yamamoto, Yuki, and Furukawa, Fukumi

Abstract

Various systemic corticosteroid therapies are used for alopecia areata ( AA). Pulse therapy using methylprednisolone is a treatment approach for AA. The efficacy of multiple courses of pulse therapy for various severities of AA was evaluated. AA patients with less than 50% hair loss, less than or equal to 6 months after AA onset, needed 1.9 courses of pulse therapy for vellus hair to develop. On the other hand, AA patients with more than 50% hair loss, less than 6 months after AA onset, needed more courses of pulse therapy for vellus hair to develop. Regardless of the disease duration, AA patients with less than 50% hair loss showed a good response rate (100%) after both a short period and a long period after therapy. After receiving multiple courses of pulse therapy, the AA patients with more than 50% hair loss also showed improvement with limited adverse reactions. [ABSTRACT FROM AUTHOR]

Published
2016
Full Text
View/download PDF

12. Antenatal corticosteroid treatment: what's happened since Drs Liggins and Howie?

Author

Bonanno, Clarissa and Wapner, Ronald J.

Subjects
CORTICOSTEROIDS, HORMONE therapy, RESPIRATORY distress syndrome, NEONATAL mortality, MEDICAL personnel, PREVENTION of pregnancy complications, PREMATURE labor, PRENATAL drug exposure, RESPIRATORY therapy for newborn infants, SODIUM channels, PREVENTION
Abstract

In 1972, Drs Liggins and Howie published a landmark article demonstrating that antenatal corticosteroids significantly reduced the frequency of respiratory distress syndrome and neonatal mortality. A single course of antenatal corticosteroids has become standard of care for pregnant women at risk for preterm birth. Recent studies have suggested weekly courses of antenatal corticosteroids result in improvement in the acute neonatal condition but have not supported long-term benefit. With greater understanding of the beneficial actions of corticosteroids on the fetal lung, the role for this therapy may expand. In addition to increased surfactant production and secretion, corticosteroids facilitate clearance of fetal lung fluid, as well as other maturational effects. Thus, antenatal corticosteroids may prove valuable in the late preterm period and before elective cesarean delivery at term. [Copyright &y& Elsevier]

Published
2009
Full Text
View/download PDF

13. Multiple courses of antenatal corticosteroid therapy in patients with preterm premature rupture of membranes.

Author

Soon Ha Yang, Suk Joo Choi, Cheong Rae Roh, and Jong Hwa Kim

Subjects
*CORTICOSTEROIDS, *PREGNANCY, *RESPIRATORY distress syndrome, *REGRESSION analysis, *UNIVARIATE analysis
Abstract

Objective: This study was performed to determine the benefits and risks of multiple courses of corticosteroids in patients with preterm premature rupture of membranes (PPROM). Method: We retrospectively evaluated the pregnancy and neonatal outcomes of women with singleton pregnancies, who were admitted at 24-32 weeks of gestation due to PPROM. Patients were categorized into 3 groups according to antenatal corticosteoid exposure: (1) a nonuser group, (2) a single-course group, and (3) a multiplecourse group. Result: A total of 170 patients were included in the study, with 50 in the non-use group, 76 in the single-course group, and 44 in the multiple-course group. Univariate analyses showed that clinical chorioamnionitis occurred with highest incidence in multiple-course group (X²=6.20, p<0.05) and the incidence of neonatal respiratory distress syndrome (RDS) was lowest in the multiple- course group (X²=10.0, p<0.01). Multiple logistic regression analyses showed that multiple courses of corticosteroids were independently associated with clinical chorioamnionitis (odds ratio=13.15, p<0.05) whereas no significant association was found between RDS and multiple-course corticosteroids after adjusting for confounding variables (odds ratio=0.28, p=0.06). Conclusion: Multiple courses of antenatal corticosteroid therapy were found to be associated with an increased risk of clinical chorioamnionitis and seemed not to reduce the incidence of RDS and other neonatal morbidities in patients with PPROM. [ABSTRACT FROM AUTHOR]

Published
2004

14. Low-dose betamethasone-acetate for fetal lung maturation in preterm sheep

Author

Schmidt, Augusto F., Kemp, Matthew W., Rittenschober-Böhm, Judith, Kannan, Paranthaman S., Usuda, Haruo, Saito, Masatoshi, Furfaro, Lucy, Watanabe, Shimpei, Stock, Sarah, Kramer, Boris W., Newnham, John P., Kallapur, Suhas G., Jobe, Alan H., RS: GROW - R4 - Reproductive and Perinatal Medicine, RS: MHeNs - R3 - Neuroscience, Kindergeneeskunde, and MUMC+: MA Medische Staf Kindergeneeskunde (9)

Subjects
PHARMACOKINETICS, Pulmonary Surfactant-Associated Proteins, ANTENATAL CORTICOSTEROIDS, ATP Binding Cassette Transporter, Subfamily A, BIRTH, ATP Binding Cassette Transporter, GLUCOCORTICOID TREATMENT, Messenger, fetal lung maturation, betamethasone, TERM, Article, Dose-Response Relationship, Paediatrics and Reproductive Medicine, Fetal Organ Maturity, Models, Pregnancy, Animals, RNA, Messenger, Obstetrics & Reproductive Medicine, Lung, Glucocorticoids, GESTATIONAL-AGE, MULTIPLE COURSES, Sheep, Dose-Response Relationship, Drug, BORN, Animal, Sub-Family A, NEONATAL-MORTALITY, prematurity, RANDOMIZED CONTROLLED-TRIAL, antenatal corticosteroids, Aquaporin 5, Subfamily A, PREGNANCY, RESPIRATORY-DISTRESS, Models, Animal, RNA, Female, TRIAL, Drug
Abstract

BACKGROUND: Antenatal steroids are standard of care for women who are at risk of preterm delivery; however, antenatal steroid dosing and formulation have not been evaluated adequately. The standard clinical 2-dose treatment with betamethasone-acetate+betamethasone-phosphate is more effective than 2 doses of betamethasone-phosphate for the induction of lung maturation in preterm fetal sheep. We hypothesized that the slowly released betamethasone-acetate component induces similar lung maturation to betamethasone-phosphate+betamethasone-acetate with decreased dose and fetal exposure. OBJECTIVE: The purpose of this study was to investigate pharmacokinetics and fetal lung maturation of antenatal betamethasone-acetate in preterm fetal sheep. STUDY DESIGN: Groups of 10 singleton-pregnant ewes received 1 or 2 intramuscular doses 24 hours apart of 0.25 mg/kg/dose of betamethasone-phosphate+betamethasone-acetate (the standard of care dose) or 1 intramuscular dose of 0.5 mg/kg, 0.25 mg/kg, or 0.125 mg/kg of betamethasone-acetate. Fetuses were delivered 48 hours after the first injection at 122 days of gestation (80% of term) and ventilated for 30 minutes, with ventilator settings, compliance, vital signs, and blood gas measurements recorded every 10 minutes. After ventilation, we measured static lung pressure-volume curves and sampled the lungs for messenger RNA measurements. Other groups of pregnant ewes and fetuses were catheterized and treated with intramuscular injections of betamethasone-phosphate 0.125 mg/kg, betamethasone-acetate 0.125 mg/kg, or betamethasone-acetate 0.5 mg/kg. Maternal and fetal betamethasone concentrations in plasma were measured for 24 hours. RESULTS: All betamethasone-treated groups had increased messenger RNA expression of surfactant proteins A, B, and C, ATP-binding cassette subfamily A member 3, and aquaporin-5 compared with control animals. Treatment with 1 dose of intramuscular betamethasone-acetate 0.125mg/kg improved dynamic and static lung compliance, gas exchange, and ventilation efficiency similarly to the standard treatment of 2 doses of 0.25 m/kg of betamethasone-acetate+betamethasone-phosphate. Betamethasone-acetate 0.125 mg/kg resulted in lower maternal and fetal peak plasma concentrations and decreased fetal exposure to betamethasone compared with betamethasone-phosphate 0.125 mg/kg. CONCLUSION: A single dose of betamethasone-acetate results in similar fetal lung maturation as the 2-dose clinical formulation of betamethasone-phosphatethornbetamethasone-acetate with decreased fetal exposure to betamethasone. A lower dose of betamethasone-acetate may be an effective alternative to induce fetal lung maturation with less risk to the fetus.

Published
2017

15. Antenatal Corticosteroid Exposure Disrupts Myelination in the Auditory Nerve of Preterm Sheep

Author

Jennifer Rodger, Suhas G. Kallapur, Stephen G. Matthews, Judith Rittenschober-Böhm, Angelika Berger, John P. Newnham, Boris W. Kramer, Yuichiro Miura, Matthew W. Kemp, Alan H. Jobe, Matthew S. Payne, Dorota A. Doherty, Michael Archer, Christian Rittenschober, RS: GROW - R4 - Reproductive and Perinatal Medicine, RS: MHeNs - R3 - Neuroscience, Kindergeneeskunde, and MUMC+: MA Medische Staf Kindergeneeskunde (9)

Subjects
FETAL SHEEP, medicine.medical_treatment, GLUCOCORTICOID TREATMENT, Betamethasone, Myelin, Myelination, Random Allocation, 0302 clinical medicine, Auditory nerve, Pregnancy, 030212 general & internal medicine, Saline, Myelin Sheath, OUTCOMES, Gestational age, Antenatal corticosteroid, medicine.anatomical_structure, Regression Analysis, Female, Intramuscular injection, Neurosensory development, LUNG MATURATION, medicine.drug, Antenatal corticosteroids, medicine.medical_specialty, BIRTH, Gestational Age, CONTROLLED-TRIAL, 03 medical and health sciences, Fetus, Microscopy, Electron, Transmission, Internal medicine, medicine, Preterm lamb, Animals, Cochlear Nerve, Glucocorticoids, MULTIPLE COURSES, Sheep, business.industry, STEROIDS, medicine.disease, Endocrinology, Pediatrics, Perinatology and Child Health, AGE MACS-5, business, 030217 neurology & neurosurgery, Developmental Biology
Abstract

Background: Antenatal corticosteroids (ACS) improve preterm neonatal outcomes. However, uncertainty remains regarding the safety of ACS exposure for the developing fetus, particularly its neurosensory development. Objectives: We investigated the effect of single and multiple ACS exposures on auditory nerve development in an ovine model of pregnancy. Methods: Ewes with a single fetus (gestational age [GA] 100 days) received an intramuscular injection of 150 mg medroxyprogesterone-acetate, followed by intramuscular (i) betamethasone (0.5 mg/kg) on days 104, 111, and 118 GA; (ii) betamethasone on day 104 and saline on days 111 and 118 GA; or (iii) saline on days 104, 111, and 118 GA, with delivery on day 125 GA. Transmission electron microscope images of lamb auditory nerve preparations were digitally analyzed to determine auditory nerve morphology and myelination. Results: Relative to the control, mean auditory nerve myelin area was significantly increased in the multiple-treatment group (p < 0.001), but not in the single-treatment group. Increased myelin thickness was significantly changed only in a subgroup analysis for those axons with myelin thickness greater than the median value (p < 0.001). Morphological assessments showed that the increased myelin area was due to an increased likelihood of decompacted areas (p = 0.005; OR = 2.14, 95% CI 1.26–3.63; 31.6 vs. 18.2% in controls) and irregular myelin deposition (p = 0.001; OR = 5.91, 95% CI 2.16–16.19; 49.0 vs. 16.8% in controls) in the myelin sheath. Conclusions: In preterm sheep, ACS exposure increased auditory nerve myelin area, potentially due to disruption of normal myelin deposition.

Published
2017

16. Retrospective survey of serum lipids in patients receiving more than three courses of isotretinoin.

Author

Ling, T. C., Barth, J. H., Cunliffe, W. J., and Baxter, K. F.

Subjects
*ISOTRETINOIN, *DRUG side effects, *HYPERLIPIDEMIA, *TRIGLYCERIDES, *SKIN disease treatment, *ACNE, *BLOOD lipids, *DISEASE risk factors
Abstract

Isotretinoin is well recognised to cause hyperlipidaemia. This is most obvious during the second month of a 4-month course. Since there are no long-term data on lipid profiles, we have identified 30 subjects who have received 3 or more courses of isotretinoin. They had been exposed to a median of 24.5 months (range 12-103) isotretinoin therapy with a median total cumulative dose of 350 mg/kg (range 152-1221). The median serum cholesterol pre-treatment was 4.6 mmol/L (range 3-6.4). This compared to a median of 4.5 mmol/L (range 3-6.4) just prior to starting the final course. The median triglyceride levels before treatment and pre-final course were 0.8 mmol/L (range 0.3-1.7) and 0.92 mmol/L (range 0.4-2.6) respectively, indicating no significant change in cholesterol or triglyceride concentrations when measured prior to the first and last courses. In addition there was no correlation between cholesterol or triglyceride concentration before the final course of isotretinoin and the total cumulative dose of isotretinoin. We conclude that there appears to be little risk of causing hyperlipidaemia by prolonged therapy with isotretinoin in patients with acne. [ABSTRACT FROM AUTHOR]

Published
2003

17. Low-dose betamethasone-acetate for fetal lung maturation in preterm sheep

Subjects
PHARMACOKINETICS, ANTENATAL CORTICOSTEROIDS, BORN, NEONATAL-MORTALITY, BIRTH, GLUCOCORTICOID TREATMENT, prematurity, fetal lung maturation, RANDOMIZED CONTROLLED-TRIAL, betamethasone, TERM, PREGNANCY, RESPIRATORY-DISTRESS, TRIAL, GESTATIONAL-AGE, MULTIPLE COURSES
Abstract

BACKGROUND: Antenatal steroids are standard of care for women who are at risk of preterm delivery; however, antenatal steroid dosing and formulation have not been evaluated adequately. The standard clinical 2-dose treatment with betamethasone-acetate+betamethasone-phosphate is more effective than 2 doses of betamethasone-phosphate for the induction of lung maturation in preterm fetal sheep. We hypothesized that the slowly released betamethasone-acetate component induces similar lung maturation to betamethasone-phosphate+betamethasone-acetate with decreased dose and fetal exposure. OBJECTIVE: The purpose of this study was to investigate pharmacokinetics and fetal lung maturation of antenatal betamethasone-acetate in preterm fetal sheep. STUDY DESIGN: Groups of 10 singleton-pregnant ewes received 1 or 2 intramuscular doses 24 hours apart of 0.25 mg/kg/dose of betamethasone-phosphate+betamethasone-acetate (the standard of care dose) or 1 intramuscular dose of 0.5 mg/kg, 0.25 mg/kg, or 0.125 mg/kg of betamethasone-acetate. Fetuses were delivered 48 hours after the first injection at 122 days of gestation (80% of term) and ventilated for 30 minutes, with ventilator settings, compliance, vital signs, and blood gas measurements recorded every 10 minutes. After ventilation, we measured static lung pressure-volume curves and sampled the lungs for messenger RNA measurements. Other groups of pregnant ewes and fetuses were catheterized and treated with intramuscular injections of betamethasone-phosphate 0.125 mg/kg, betamethasone-acetate 0.125 mg/kg, or betamethasone-acetate 0.5 mg/kg. Maternal and fetal betamethasone concentrations in plasma were measured for 24 hours. RESULTS: All betamethasone-treated groups had increased messenger RNA expression of surfactant proteins A, B, and C, ATP-binding cassette subfamily A member 3, and aquaporin-5 compared with control animals. Treatment with 1 dose of intramuscular betamethasone-acetate 0.125mg/kg improved dynamic and static lung compliance, gas exchange, and ventilation efficiency similarly to the standard treatment of 2 doses of 0.25 m/kg of betamethasone-acetate+betamethasone-phosphate. Betamethasone-acetate 0.125 mg/kg resulted in lower maternal and fetal peak plasma concentrations and decreased fetal exposure to betamethasone compared with betamethasone-phosphate 0.125 mg/kg. CONCLUSION: A single dose of betamethasone-acetate results in similar fetal lung maturation as the 2-dose clinical formulation of betamethasone-phosphatethornbetamethasone-acetate with decreased fetal exposure to betamethasone. A lower dose of betamethasone-acetate may be an effective alternative to induce fetal lung maturation with less risk to the fetus.

Published
2018

19. Prescribing patterns of antenatal corticosteroids in women with threatened preterm labor

Author

Frank P.H.A. Vandenbussche, Patrick M.M. Bossuyt, Jim van Eyck, Joris A. M. van der Post, Krystyna M. Sollie, Jérôme Cornette, Gert Jan Van Baaren, Ben W.J. Mol, Bas Nij Bijvank, Anneke Kwee, Johannes J. Duvekot, Mallory Woiski, Femke F. Wilms, Caroline J. Bax, Jolande Y. Vis, Martijn A. Oudijk, Martina Porath, Maureen T.M. Franssen, Antoinette C. Bolte, Hubertina C.J. Scheepers, Kitty W.M. Bloemenkamp, Marc E. A. Spaanderman, Brent C. Opmeer, Obstetrics and gynaecology, ICaR - Ischemia and repair, Obstetrics & Gynecology, Public Health, Other departments, Amsterdam Reproduction & Development (AR&D), Obstetrics and Gynaecology, Amsterdam Public Health, 10 Public Health & Methodologie, Clinical Research Unit, Reproductive Origins of Adult Health and Disease (ROAHD), MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Obstetrie & Gynaecologie, RS: GROW - Developmental Biology, and RS: GROW - R4 - Reproductive and Perinatal Medicine

Subjects
Adult, Antenatal corticosteroids, medicine.medical_specialty, Time Factors, Preterm labor, BIRTH, RESPIRATORY-DISTRESS-SYNDROME, Gestational Age, Drug Prescriptions, MATURATION, law.invention, Young Adult, DELIVERY, Obstetric Labor, Premature, Randomized controlled trial, law, Adrenal Cortex Hormones, Pregnancy, medicine, Journal Article, Humans, Prospective Studies, Medical prescription, Practice Patterns, Physicians', Prospective cohort study, Cervical length, MULTIPLE COURSES, OUTCOMES, Fetal fibronectin, Obstetrics, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Obstetrics and Gynecology, Prenatal Care, RANDOMIZED CONTROLLED-TRIAL, Cervical Length Measurement, Fibronectins, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Reproductive Medicine, COST SAVINGS, CERVICAL LENGTH MEASUREMENT, Gestation, Premature Birth, Female, business
Abstract

Objective: To assess the impact of cervical length (CL) measurement and fetal fibronectin testing (fFN) on the clinicians' decision to prescribe antenatal corticosteroids (ACS) to women with symptoms of preterm labor.Study design: This is a secondary analysis of a prospective cohort study including women with symptoms of preterm labor and intact membranes between 24 and 34 weeks' gestation. We compared the proportion prescribed and completed ACS courses, preterm delivery within seven days and median intervals from ACS to delivery in four groups: group 1 CL 30 mm.Results: ACS were prescribed to 63/65 (97%) women in group 1, 176/192 (91%) in group 2, 111/172 women (65%) in group 3 and 55/242(23%) in group 4. In group 1, 42 (65%) women delivered within seven days, compared to 34(18%) in group 2, 6 (3%) in group 3 and 3 (1%) in group 4. Median intervals between ACS and delivery were 6 days (IQR 3-61 days), 44 days (IQR 17-69 days), 53 days (IQR 37-77 days) and 66 days (IQR 43-78 days) in group 1, 2, 3 and 4 respectively.Conclusion: ACS were prescribed frequently to women with a CL of 10-30 mm and a negative fFN test or a CL > 30 mm. There is room for improvement in the prescription of ACS in these low risk women. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Published
2015

21. Repeated courses of ibuprofen are effective in closure of a patent ductus arteriosus

Author

Frans J. Walther, Regina Bökenkamp, Vivianne E.H.J. Smits-Wintjens, N. Margreth van der Lugt, Sylke J. Steggerda, and Enrico Lopriore

Subjects
Male, medicine.medical_specialty, Multiple courses, Patent ductus arteriosus, Ibuprofen, Infant, Premature, Diseases, Tertiary care, Drug Administration Schedule, Ductus arteriosus, Medicine, Humans, Cyclooxygenase Inhibitors, Closure (psychology), Side effects, Ductus Arteriosus, Patent, Retrospective Studies, business.industry, organic chemicals, Infant, Newborn, Gestational age, Retrospective cohort study, Surgery, Predictive factor, medicine.anatomical_structure, Treatment Outcome, Anesthesia, Pediatrics, Perinatology and Child Health, Injections, Intravenous, Female, business, Complication, Infant, Premature, medicine.drug
Abstract

Patent ductus arteriosus (PDA) is a frequent complication in preterm infants. Ibuprofen and indomethacin (both COX inhibitors) are used for pharmacological closure of PDA. In most centers, a failed second course of COX inhibitors is followed by surgical closure. Our aim was to estimate the closure rate of clinically significant PDA after second and third courses of ibuprofen and record possible side effects. A study population, consisting of 164 preterm infants (

Published
2012

22. Three or More Courses of Stereotactic Radiosurgery for Patients with Multiply Recurrent Brain Metastases.

Author

Kotecha R, Damico N, Miller JA, Suh JH, Murphy ES, Reddy CA, Barnett GH, Vogelbaum MA, Angelov L, Mohammadi AM, and Chao ST

Subjects
Adult, Aged, Aged, 80 and over, Brain Neoplasms mortality, Female, Humans, Karnofsky Performance Status, Male, Middle Aged, Neoplasm Recurrence, Local surgery, Proportional Hazards Models, Quality of Life, Radiosurgery mortality, Retrospective Studies, Brain Neoplasms radiotherapy, Brain Neoplasms secondary, Radiosurgery methods, Salvage Therapy methods
Abstract

Background: Although patients with brain metastasis are treated with primary stereotactic radiosurgery (SRS), the use of salvage therapies and their consequence remains understudied., Objective: To study the intracranial recurrence patterns and salvage therapies for patients who underwent multiple SRS courses., Methods: A retrospective review was performed of 59 patients with brain metastases who underwent ≥3 SRS courses for new lesions. Cox regression analyzed factors predictive for overall survival., Results: The median age at diagnosis was 52 years. Over time, patients underwent a median of 3 courses of SRS (range: 3-8) to a total of 765 different brain metastases. The 6-month risk of distant intracranial recurrence after the first SRS treatment was 64% (95% confidence interval: 52%-77%). Overall survival was 40% (95% confidence interval: 28%-53%) at 24 months. Only 24 patients (41%) had a decline in their Karnofsky Performance Status ≤70 at last office visit. Quality of life was preserved among 77% of patients at 12 months, with 45% experiencing clinically significant improvement during clinical follow-up. Radiation necrosis developed in 10 patients (17%). On multivariate analysis, gender (males, Hazard Ratio [HR]: 2.0, P < .05), Karnofsky Performance Status ≤80 (HR 3.2, P < .001), extracranial metastases (HR: 3.6, P < .001), and a distant intracranial recurrence ≤3 months from initial to repeat SRS (HR: 3.8, P < .001) were associated with a poorer survival., Conclusion: In selected patients, performing ≥3 SRS courses controls intracranial disease. Patients may need salvage SRS for distant intracranial relapse, but focal retreatments are associated with modest toxicity, do not appear to negatively affect a patient's performance status, and help preserve quality of life., (Copyright © 2017 by the Congress of Neurological Surgeons)

Published
2017
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results