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Aims: Endometrial cancer is the most common gynaecological cancer, and there is a growing interest in identifying the molecular pathways involved and developing molecular-targeted treatment to prevent it. Present study was aimed to give an overview of the molecular processes involved in endometrial cancer development and treatment options. Methods: We conducted a comprehensive systematic literature review and meta-analysis. For that purpose, PubMed database was searched for related studies till June 2021 and a through selection process was adopted to select the eligible studies. Results: Endometrial malignancies are complicated molecularly, and their focused therapy has a wide range of outcomes, with median progressive survival rates ranging from 2.3 to 18 months. Conclusions: The effective treatment and therapy need a detailed understanding of the molecular mechanisms underlying the creation and progression of endometrial cancer, as well as the development of innovative targeted therapeutic agents.

Context: Multisystem Inflammatory Syndrome in Children (MISC) is a newly and rising condition, particularly in SARS-CoV-2 high transmission communities. Objective: Analyze current literature and reported cases of MISC, concerning its clinical spectrum, complications associated, therapeutic strategies and distinguishing features of other clinical syndromes. Data Sources: Extensive literature research was performed in MEDLINE (trough PubMed), Scopus and Web of Science from December 2019 to December 2020.Study Selection: First analysis included all article titles and abstracts screening to identify relevant studies and second analysis included a full text screening of previous selected studies. Eligibility was assessed independently by two authors and disagreements were resolved by discussion and consensus. Data Extraction: Data were extracted on MISC definition, demographic data, clinical features, diagnostic tests, laboratory analysis andimaging, therapeutical approach and outcomes. Results: Common symptoms included: gastrointestinal (70%), rash (57%) and cardiovascular (52% with shock). Notable differences with Kawasaki Disease were identified including age, clinical presentation and cardiac involvement. 30% presented positive SARS-CoV-2 2 reverse transcription polymerase chain reaction and 51% positive serologies. 62% received intravenous immunoglobulin and 42% glucocorticoids. 62% required intensive care, 21 children died (

PURPOSE We assessed differences in compliance and adherence (lateness of patients, visual acuity, reasons for abstaining) between patients with diabetic macular edema (DME) and patients with age-related macular degeneration (AMD), both under anti-vascular endothelial growth factor therapy. METHODS We included 136 patients with DME (36% women, 65 years, 22 visits, 13.9 injections, and 29.9 months of follow-up) and 109 patients with AMD (59% women, 76 years, 20 visits, 14.7 injections, and 22.3 months of follow-up) (minimum follow-up of 12 months and at least 5 injections). We assessed missed appointments (lateness >14 days) and therapy break-offs (lateness >100 days). All delayed patients were called and interviewed for abstaining reasons. RESULTS Forty-six percent of patients with DME and 22% of patients with AMD had at least one break-off. Thirty-five percent of patients with DME and 50% of patients with AMD were always on schedule. In patients with DME, there was significant correlation (P = 0.017) between the number of break-offs and change of visual acuity. In 60% DME and 38% AMD of break-off cases, visual acuity was worse than the before break-off. The most common reason for abstaining was comorbidities (33% AMD and 20% DME). CONCLUSION There are significant differences between patients with AMD and DME regarding compliance and adherence, which also affects outcome. Strategies to tie patients with DME to costly intravitreal therapy need to be developed to improve outcomes and efficacy.

// Dehui Xu 1, 2, * , Yujing Xu 1, * , Qingjie Cui 2 , Dingxin Liu 1 , Zhijie Liu 1 , Xiaohua Wang 1 , Yanjie Yang 3 , Miaojuan Feng 4 , Rong Liang 4 , Hailan Chen 5 , Kai Ye 6, 7 and Michael G. Kong 1, 5, 8 1 State Key Laboratory of Electrical Insulation and Power Equipment, Center for Plasma Biomedicine, Xi’an Jiaotong University, Xi’an, Shaanxi, 710049, P.R. China 2 The School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, 710049, P.R. China 3 Department of Cardiovascular Medicine, First Affiliated Hospital of the Medical School, Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, P.R. China 4 Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, 710032, P.R. China 5 Frank Reidy Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA 6 School of Electronic and Information Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, 710049, P.R. China 7 First Affiliated Hospital of the Medical School, Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, P.R. China 8 Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23529, USA * These authors have contributed equally to this work Correspondence to: Michael G. Kong, email: mkong@odu.edu Kai Ye, email: ed_kaiye@mail.xjtu.edu.cn Keywords: multiple myeloma; cold atmospheric plasma; reactive oxygen species; CD95; selective inactivation Received: November 09, 2017 Accepted: January 30, 2018 Published: April 06, 2018 ABSTRACT Multiple myeloma (MM) is a fatal and incurable hematological malignancy thus new therapy need to be developed. Cold atmospheric plasma, a new technology that could generate various active species, could efficiently induce various tumor cells apoptosis. More details about the interaction of plasma and tumor cells need to be addressed before the application of gas plasma in clinical cancer treatment. In this study, we demonstrate that He+O 2 plasma could efficiently induce myeloma cell apoptosis through the activation of CD95 and downstream caspase cascades. Extracellular and intracellular reactive oxygen species (ROS) accumulation is essential for CD95-mediated cell apoptosis in response to plasma treatment. Furthermore, p53 is shown to be a key transcription factor in activating CD95 and caspase cascades. More importantly, we demonstrate that CD95 expression is higher in tumor cells than in normal cells in both MM cell lines and MM clinical samples, which suggests that CD95 could be a favorable target for plasma treatment as it could selectively inactivate myeloma tumor cells. Our results illustrate the molecular details of plasma induced myeloma cell apoptosis and it shows that gas plasma could be a potential tool for myeloma therapy in the future.

Taiwan is commonly noted for its high prevalence of myopia, as well as a long history of more than 20 years of using atropine to control myopia. However, the clinical implications are rarely discussed. This is a cross-sectional study investigating the influence of topical atropine instillation on ocular physiology, visual function, and visual discomfort in children. Aged 7 to 12 years, 212 schoolchildren were recruited and divided into the atropine group and the non-atropine group. Physiological characteristics such as pupil size and intraocular pressure were measured, and a variety of visual functions was also evaluated. A questionnaire was used to investigate the side effects and visual complaints caused by atropine treatment. There was a significant difference in pupil size (OD: 5.40 ± 0.90 vs. 6.60 ± 1.01 mm, OS: 5.42 ± 0.87 vs. 6.64 ± 1.00 mm, p &lt, 0.001) between the two groups. Reductions in near visual acuity, accommodation, convergence ability, and stereopsis were observed in the atropine group. The horizontal pupil diameter enlarged, and visual functions were greatly affected after administration of topical atropine. The changes in visual function during atropine therapy need to be carefully monitored by clinicians, while patient compliance is usually the key to success.

The most common cause of dementia, especially in elderly people, is Alzheimer’s disease (AD), with aging as its main risk factor. AD is a multifactorial neurodegenerative disease. There are several factors increasing the risk of AD development. One of the main features of Alzheimer’s disease is impairment of brain energy. Hypometabolism caused by decreased glucose uptake is observed in specific areas of the AD-affected brain. Therefore, glucose hypometabolism and energy deficit are hallmarks of AD. There are several hypotheses that explain the role of glucose hypometabolism in AD, but data available on this subject are poor. Reduced transport of glucose into neurons may be related to decreased expression of glucose transporters in neurons and glia. On the other hand, glucose transporters may play a role as potential targets for the treatment of AD. Compounds such as antidiabetic drugs, agonists of SGLT1, insulin, siRNA and liposomes are suggested as therapeutics. Nevertheless, the suggested targets of therapy need further investigations.

Diaphoresis therapy to remove water and solutes for the treatment of advanced chronic kidney disease (CKD) and chronic dialysis patients is an inadequately characterized treatment that was first reported over 50 years ago. Intensive diaphoresis, induced by heat treatment with saunas (dry heat) or hot baths (wet heat), can substantially increase cutaneous losses of water, urea, sodium, potassium, chloride, lactate, and possibly other solutes. How effectively diaphoresis therapy might remove many uremic toxins is not known. Diaphoresis therapy is not sufficiently effective to replace dialysis treatments, but theoretically it might be used to delay the start of chronic dialysis, supplement infrequent dialysis therapy, or augment chronic dialysis treatment perhaps especially for dialysis patients with excessive salt and water intake. Diaphoresis might be helpful for managing edema resistant states. Because it is inexpensive, diaphoresis may be particularly valuable in lower income countries where some patients may need to pay for dialysis. Diaphoresis might enhance some aspects of dietary treatment. The short-term and long-term effectiveness, safety, and patient acceptance of diaphoretic therapy need to be more carefully investigated.

To propose that low dose aspirin therapy need not be withdrawn for routine dental extraction procedure.This study was designed to evaluate the post operative bleeding in patients on low dose aspirin therapy by dividing them into two groups: one with withdrawing and the other without withdrawing the regime before dental extraction.This study included 80 patients on low dose aspirin therapy. They were divided into two groups of 40 patients each; Group I (control group) included patients on who were asked to stop the medication 5 days prior to dental extraction; Group II (test group) included patients who were asked not to stop the medication prior to dental extraction. Strict atraumatic extractions were performed by a single surgeon. Data were analyzed using the independent "The mean pre-operative bleeding time in the control group was 87.75 s and the test group was 95.75 s which was statistically significant (Authors conclude from this study that dental extraction procedures in patients on low-dose therapy can be safely carried out without stopping the antiplatelet therapy.

Deep endometriosis remains a source of controversy. A number of theories may explain its pathogenesis and many arguments support the hypothesis that genetic or epigenetic changes are a prerequisite for development of lesions into deep endometriosis. Deep endometriosis is frequently responsible for pelvic pain, dysmenorrhea, and/or deep dyspareunia, but can also cause obstetrical complications. Diagnosis may be improved by high-quality imaging. Therapeutic approaches are a source of contention as well. In this issue's Views and Reviews, medical and surgical strategies are discussed, and it is emphasized that treatment should be designed according to a patient's symptoms and individual needs. It is also vital that referral centers have the knowledge and experience to treat deep endometriosis medically and/or surgically. The debate must continue because emerging trends in therapy need to be followed and investigated for optimal management.

Prosthetic joint infection (PJI) is a rare but serious complication that is frequently misdiagnosed. We aimed to highlight the nuances of PJI diagnosis and antimicrobial therapies and provide clarity in key areas of management. Current research in PJI centers on a potential role for diagnostic biomarkers, molecular techniques, and implant sonication to reduce culture-negativity rates. The optimal duration of antimicrobial therapy remains controversial. A high clinical index of suspicion for PJI combined with data from multiple preoperative and intraoperative tests enables timely diagnosis and treatment. Biomarkers, molecular methods, and implant sonication are currently adjunctive to traditional diagnostic techniques. Shorter courses of antimicrobial therapies as well as the role of chronic suppressive therapy need confirmation by randomized controlled trials. Existing practices for preoperative dental prophylaxis and treatment of asymptomatic bacteriuria warrant revision based on evidence arguing against risk for PJI.

International audience; Background: Epigenetic changes play crucial roles in cancer initiation and progression and in tumor recurrence. Glioblastoma multiforme (GBM) is by far the most common and most malignant of the glial tumors, and its recurrence is ineluctable. Thus, anti-GBM therapy need for new treatments for recurrent GBM. We here in focused on identifying whether TET2 (an epigenetic players involving in the DNA demethylation process) as a putative target for the development of anti-GBM therapy.Results: We observed that the expression level of TET2 at mRNA and protein levels is not associated with a prognosis value of survival in GBM patients. However, in a cohort of 10 GBM patients having received two surgical resections (rGBM), we noted that three in ten rGBM patients have an increase of TET2 expression between resection#1 and #2.Conclusions: By observing an increase of TET2 expression between two surgical resections an despite the fact that expression level of TET2 is devoid of prognosis value of survival in GBM patients, our data provide a promising starting point for the use of TET2 inhibitors administrable in the subgroup of patients with recurrent GBM.

Los cuidadores de pacientes en terapia de diálisis peritoneal requieren fortalecer su habilidad de cuidado. Objetivo: Describir la experiencia del cuidador familiar que cuida a personas en diálisis peritoneal que asisten al programa "Cuidando a los cuidadores"© Versión institucional". Metodología: Estudio cualitativo de tipo descriptivo, realizado en el primer semestre de 2015, con una muestra conformada por 277 relatos de cuidadores familiares de personas en diálisis peritoneal que asistieron al programa "Cuidando a los Cuidadores© versión institucional". Para el análisis de los datos se utilizó el programa Atlas Ti versión 6.0; construyendo una taxonomía inductiva de los hallazgos, reduciendo los códigos descriptores a nominales y estos a su vez a categorías de análisis, mediante técnicas de análisis de contenido. Se realizó proceso de consentimiento informado. Resultados: Dentro de las características de los cuidadores se encontró que en su mayoría son mujeres en edad productiva, que son las madres, hijas o esposas del familiar a quien cuidan. Se construyeron 7 categorías de análisis: nuevos conocimientos, interacción con otros, apoyo, descansar, bienestar, oportunidad de mejorar, nueva perspectiva. Conclusiones: La experiencia de participar en el programa Cuidando a los Cuidadores© versión institucional", es una experiencia que va desde adquirir nuevos conocimientos hasta tener una nueva perspectiva como cuidador.

Decisions on antiplatelet therapy may appear increasingly complex, and vary according to the clinical situation. Concerning P2Y12 antagonists, drug choice, administration route, timing of administration, and duration of therapy need to be factored into the decision making. There are less evidence

Ocular inflammations are common diseases that may lead to serious vision‐threatening obstacles. Eye drops for antiinflammation therapy need to be administered multiple times daily at a high dosage due to the rapid precorneal removal and low bioavailability of drugs. To overcome these problems, a cRGD‐functionalized DSPE‐PEG2000 nanomicelle (DSPE‐PEG2000‐cRGD) encapsulated with flurbiprofen is proposed. The tailored nanomicelles trigger specific binding to integrin receptors on the ocular surface, which leads to rapid and robust mucoadhesion, superior ocular surface retention, and transcorneal penetration behaviors of nanomicelles. Due to the enhanced drug delivery on ocular surface and in aqueous humor, the functionalized nanoformulation significantly improves ocular antiinflammation efficacy at a low dosage by blocking the synthesis of inflammatory mediators and cytokines. The present study demonstrates a promising strategy that uses a functional peptide combined with nanomicelles for targeted delivery to the eye in ophthalmologic applications.

When clinical trial enrollment is not an option for seriously ill patients whose illnesses have not responded to approved treatment options, those patients and their physicians may consider gaining access to investigational therapies through a pathway established by the Food and Drug Administration (FDA) called expanded access. However, recent events have highlighted the challenging dynamics involved in accessing investigational therapies through expanded access that include a complex interplay of factors involving the patient, physician, drug company, FDA, and, increasingly, social media. The authors offer several potential strategies to streamline what is otherwise an arduous process for all involved. (1) The drug company should prospectively determine whether it will establish an expanded access program for specific drugs. (2) A central clearinghouse for companies should support registration of expanded access drugs for suitable patients. (3) The determination of whether a patient fits criteria would be made by an independent review board of clinicians. (4) An independent coordinating center is needed; academic health centers are ideally suited for that role. (5) Adequate financing of the costs of therapy need to be in place to make expanded access a reality, given frequent lack of payer coverage for therapies. (6) Further enhancement of regulatory pathways, approaches, or rules would promote expanded access. (7) Patients should explicitly acknowledge the limited data available. (8) There should be a shared, secure, technical platform to facilitate expanded access. All the authors' strategies present important prospects for improving treatment options for the most seriously ill patients.

Residual calculi after stone therapy need to be treated if they are clinically significant, mainly depending on the size of the calculi. There are different ways to detect and measure the size of residual calculi as for example KUB or computed tomography. The Uro Dyna-CT (Siemens Healthcare solutions, Erlangen, Germany) allows cross-sectional imaging and 3D reconstructions during endourological interventions. In this ex vivo study, we investigate the accuracy of imaging residual calculi with the Uro Dyna-CT. Twenty-seven artificial stones (plaster of Paris) were scanned with the Uro Dyna-CT by a special urolithiasis protocol and post-image processing with 3D-reconstruction and cross-sectional imaging was performed. The major diameter of each stone was measured at the dedicated workstation by one investigator. The same stones were measured randomized with a digital caliper (real size). Finally, the two measurements were compared. The paired t test, Pearson’s correlation coefficient, the F Test, a reference area for differences, the intraclass correlation coefficient, the Maloney–Rastogi test and the Bland–Altman analysis were used for statistical analyses. The range of stone sizes was 3–5 mm. We did not find significant differences in the size of the stones measured with the Uro Dyna-CT and the digital caliper (paired t test p = 0.3597) and we showed a good correlation between the two measuring methods (intraclass correlation coefficient 0.4465; p = 0.0088). Renal calculi can be measured highly accurately with the Uro Dyna-CT. Whether this technique will lead to less residual fragments after stone treatment needs to be shown in further studies.

SUMMARY This management perspective will explore the relationship between lymphedema and breast reconstruction surgery. Little data exist, but early reports suggest breast reconstruction may be associated with a lower risk of lymphedema. Theories surrounding this relationship, as well as available data on lymphatic repair theories, will be discussed. In addition, the emerging role of lymphatic surgery to prevent or reverse lymphedema will be discussed. The refinement of advanced microsurgical techniques has resulted in a renewed interest in lymphatic surgery to cure lymphedema. However, efficacy, validation of surgical results, and surgery's ability to eliminate from patients the need for daily compression garments and therapy need further study.

Background:Warfarin is a high-risk medicine, and older persons (those aged 65 years and older)1,2who take this therapy need medicines information about it that is at a level which is both understandable and comprehensive to improve their knowledge about the risks and benefits of warfarin therapy.3,4Therefore, the primary objective of this study was to report patient feedback on a Warfarin Action Plan (WAP) (leaflet) and identify patients’ preferences regarding its content and format. The secondary objective was to canvass in-depth feedback regarding the participants’ information needs and current information-seeking practices with respect to warfarin therapy.Method:In an Australian General Practice medical centre setting, a qualitative study comprising 34 individual interviews was conducted. Emergent themes were elicited via a qualitative analysis using manual inductive coding.Results:The majority of participants gave very positive feedback on the WAP leaflet, stating that it was a useful and concise resource. In canvasing this feedback, 4 themes emerged: (1) the need for information about warfarin therapy, (2) reliance on doctors and/or pharmacists for information, (3) the need for information to normalize their daily life, and (4) patients and carers acting on the new information.Conclusion:The WAP is a simple and well-received tool that meets the knowledge and education needs about warfarin therapy for older people and their carers.

Bevacizumab, one of the best-known patents of VEGF inhibitor, has demonstrated significant radiosensitive effects on various preclinical tumor models and clinical trials recently. The radiosensitive effects of this novel patent have achieved satisfactory efficacy through the following mechanisms: normalization of the tumor vasculature, overcoming resistance to radiation, inhibition of repopulation after radiation, and blockade of radiation-induced increased VEGF expression. The combination of bevacizumab with radiotherapy in the treatment of malignant tumors was an inevitable path for the further clinical development of bevacizumab and a very good opportunity for improving the curative effect of radiotherapy. However, many questions such as those regarding the bevacizumab administration dosage and schedule, radio sensitivity efficacy evaluation and multi-target radiosensitive therapy need further research. The advent of bevacizumab combined with radiation has left physicians to encounter multiple challenges as well as opportunities for improving anti-cancer drug treatments.

Size control: Particles designed for imaging and therapy need to be size tunable to ensure their optimal performance. A highly reproducible procedure for the preparation of uniform, spherical, lanthanide-based nanoparticles (NPs) was developed. The size of the particles can be predefined to an accuracy of up to a few nanometers by microwave-generated temperature control and the choice of aging time (see figure).

Despite their deleterious effects, glucocorticoids (GCs) are commonly used in various disorders in the paediatric age group. Children on GC therapy need close monitoring for growth failure and other side effects. This article gives an overview about the problems associated with GC use and the present status on their solutions.

Paediatric rheumatology has come of age. In a country as large as India with its large childhood population with rheumatic diseases, there is a great need to develop training programmes in paediatric rheumatology. Fundamental research is needed to study the incidence, prevalence and variations in clinical features of common rheumatic diseases in the Indian population. Newer modalities of therapy need to be developed to suit local needs and conditions. Tools to evaluate outcomes need to be developed to suit the cultural conditions of the land. Resources have to be developed to provide continuity of care to these children with chronic diseases in remote villages. All of this requires planning, leadership, sustained effort and collaboration between patients and physicians and between private and public agencies.

Parenteral nutrition (PN) is one of the most complex medical therapies prescribed by healthcare professionals because it is dependent on the compounding of multiple base solutions to arrive at the final formulation. The delivery of PN is associated with errors in ordering, transcribing, compounding, and delivery of the PN formulations. New compounding technologies will attempt to minimize the potential for these errors. In addition, the associated infectious complications associated with PN therapy need to be minimized. Commercially prepared, premixed, terminally sterilized PN solutions may have an impact. Broader decontamination technologies will be implemented to reduce the incidence of overall nosocomial infections. Modification of PN nutrients, particularly intravenous fat emulsions, will be provided by alternative biological sources, creating fats that may have an improved impact on the patient's immune system and ultimately affecting clinical outcomes.

Deli R, Macri LA, Radico P, Pantanali F, Grieco DL, Gualano MR, La Torre G. Orthodontic treatment attitude versus orthodontic treatment need: differences by gender, age, socio-economical status and geographical context. Community Dent Oral Community Dent Oral Epidemiol 2012; 40 (Suppl. 1): 71–76. © 2012 John Wiley & Sons A/S Abstract – Objectives: To investigate the relationship between the attitude towards orthodontic treatment and the objective level of orthodontic need, and variables like gender, socioeconomic status and geographical context, among 6- to 16-year-old children. Methods: The attitude of 2284 Italian children towards orthodontics was assessed using the Child Orthodontic Attitude Survey (COAS) questionnaire, previously validated for Italian-speaking children. The level of orthodontic need was evaluated by using the Risk of Malocclusion Assessment (ROMA) Index while socioeconomic status (SES) was based on parental job activities. The univariate analysis was performed using chi-square tests to find differences between groups for categorical variables, while multivariate analyses were conducted using logistic regression models. Results: Individuals with a higher SES had a statistically significant lower need of orthodontic treatment (P = 0.003). Children with a very high SES were from northern (20.8%) and central Italy (65.9%), while only 13.3% lived in southern Italy (P

Historically it was thought that there was an increase in the hemorrhagic complications with regards to performing transrectal ultrasound-guided prostate biopsies on patients receiving anticoagulation/antiplatelet therapy. Current literature supports continuation of anticoagulation/antiplatelet therapy without additional morbidity. We sought to systematically assess the current published evidence regarding the continuation of anticoagulation/antiplatelet therapy during transrectal ultrasound-guided prostate biopsies and comment on their clinical outcomes.

In the lead article, Hersh (2010) draws attention to the significant phase of ending therapy for clients and in particular, for their therapists. Hersh highlights three main tensions that underpin this process: real versus ideal endings, making and breaking of the therapeutic relationship, and balancing of respect for client autonomy over considerations of caseload and resources. In this paper, I offer a commentary on the first two of these issues by drawing upon my experience as a speech-language pathologist/family therapist specializing in voice, and as an academic fostering the development of student clinicians. This is then linked to parallel discussions in the recent psychoanalytic and psychotherapy literature. I support Hersh's premise that the implicit processes and emotions associated with this final phase of therapy need to be made more explicit and suggest that this is more likely to occur when clinicians acknowledge that they too experience rewards and losses in the therapeutic relationship. I challenge the notion that any therapeutic relationship once established is ever entirely broken.

Background In melanoma, radiotherapy has generally been considered as a palliative treatment option indicated only for advanced cases or disseminated disease. In the 70s of the previous century, the technological advances in radiotherapy, linked to rapid development of computer sciences, resulted in restored interest for radiotherapy in melanoma management. Although a fundamental lack of well designed prospective and/or randomized clinical trials critically influenced the integration of radiotherapy into treatment strategies in melanoma, radiotherapy was recently recognized as an indispensable part in the multidisciplinary management of patients with melanoma. Altogether, approximately 23% of melanoma patients should receive at least one course of radiotherapy during the course of the disease. In this review, radiobiological properties of melanoma that govern the decisions for the fractionation patterns used in the treatment of this disease are described. Moreover, the indications for irradiation and the results of pertinent clinical studies from the literature, creating a rationale for the use of radiotherapy in the management of this disease, are reviewed and a brief description of radiotherapy techniques is given. Conclusions Basic treatment modality in melanoma is surgery. However, whenever surgery is not radical or there are adverse prognostic factors identified on histopathological examination of resected tissue specimen, it needs to be supplemented. Also, in patients with unresectable disease or in those not being suitable for major surgery or who refuse proposed surgical intervention, other effective mode(s) of therapy need to be implemented. From this perspective, supported by clinical experiences and literature results, radiotherapy is a valuable option: it is effective and safe, in curative and palliative setting.

Overactive bladder (OAB) symptoms are an important cause of morbidity and interference in quality of life (QoL). This review considers the pertinent outcome measures currently in use in the evaluation of antimuscarinic therapy when used in the treatment of OAB symptoms. In particular, reference is made to the pivotal role of urgency and the difficulties associated with its assessment. The existing antimuscarinic agents are reviewed with particular reference to the third International Consultation on Incontinence committee’s deliberations on this subject. The limitations of scientifically conducted meta-analyses are discussed. The importance of head-to-head comparative studies is emphasised with particular reference to the contemporary literature base of reported studies. Future work needs to be targeted at patient-perceived outcomes, and study design should include outcome measures that are more meaningful to people, such as return to bladder control, achievement of normal micturition frequency and QoL. Persistence rates with therapy need to be evaluated, with evaluation of the particular factors of importance in influencing the variation between the drugs, and more studies of the effects of antimuscarinics are required in older people.

Colostrum is the first milk produced by mammals for their young ones. This transfers the passive immunity gained by the mother to the baby. The bovine colostrum (BC) can be obtained in large quantity and has properties similar to human colostrum. It has been used for various disorders of the body. It has properties to stimulate immune system, contains growth factors and many bioactive substances needed for the body to combat with wear and tear. The BC has been used for various gastrointestinal disorders, respiratory tract infection, rheumatoid arthritis, healing injured tissues of body etc. There are not much double blind placebo-controlled trials to prove its efficacy, though a lot of experience about its good effects in various disorders is available in the literature. The dosage and duration of therapy need to be worked up. The BC has potential to treat as well to prevent certain diseases in the body. In future this will prove to be a very useful product to treat and control diseases in a natural way.

The aim of this study is to show the predictive value of ALT levels for histologic findings in patients with chronic hepatitis C. The study included 115 patients with HCV infection. All of them were monitored for six months before liver biopsy was performed. In all patients routine laboratory tests were done. Normal ALT values were defined as the ALT values obtained from serial evaluations during a 6-month period. Histologic results were scored using METAVIR system. Among all patients 86.2% of those with elevated ALT levels had score at least F1 (positive predictive value (PPV) 86.2 %), and 70% had a score greater than A1 F1. Among patients with normal ALT values 58.1% had a score of at least F1 (negative predictive value (NPV) 41.6%, and 100% had a score greater than A1F1. In conclusion, almost all patients with elevated ALT levels had some degree of fibrosis. However, a significant number of patients with persistently normal ALT levels show some histologic signs of fibrosis. The degree of fibrosis was usually mild, but also sometimes more pronounced. In rare cases cirrhosis may be present. Our results suggest that in this subset of patients the indication for liver biopsy and the potential benefit of therapy need to be further evaluated. .

A child is not a “little adult” and many developmental and individual factors affect headaches; these pertain to the clinical expression, diagnosis, and therapy of the primary headache. Accordingly, several aspects must be clarified by: considering the child as a whole in his or her development; taking into account neurobiologic and psychologic maturational processes and familial, social, and environmental factors; and avoiding an adult-focused approach to the disease. Key information in the etiology, pathogenesis, diagnosis, treatment, and outcome of childhood headache must be obtained. Both diagnosis and therapy need to take into account age-related factors.

The success of osseous healing around dental implants has allowed for an increased emphasis on soft tissue healing and esthetic results. However, there is limited information profiling the long-term healing of the soft tissues following prosthesis placement. The purpose of this study was to assess the long-term changes in the position of the facial soft tissue margins following restoration of a one-stage implant system. One hundred and six one-stage ITI implants were evaluated in 39 patients. Implants were placed in maxillary and mandibular anterior regions. Clinical assessment of the soft tissues on the midfacial aspect of the implants was performed over a 2-year period, at 3 and 6 month intervals, following placement of the final restoration. A total of 63 implants were placed as multiple units in the mandible, 23 as single units in the maxilla, and 20 as multiple units in the maxilla. There were no implant failures over this time period. Overall, on the facial aspect of 61% of the 106 implants there was 1 mm or more of soft tissue recession, whereas 19% of the implants showed 1 mm or more of gain in soft tissue height. There was a significantly (P < 0.01) greater number of implants showing a gain in soft tissue levels in the mandibular implants compared with the maxillary implants. Of the 39 patients assessed, 24 showed a loss and five showed a gain of 1 mm or more of the soft tissue levels around the implants. Overall, there was a significant decrease in the mean levels of tissue height of 0.6 mm within the first 6 months, with relatively little change afterward. However, in evaluating only patients showing a loss in tissue height around one or more implants, the mean loss in tissue height was 1.6 mm after 24 months. These results suggest that the potential for significant changes in soft tissue levels after completion of restorative therapy need to be considered for implant therapy in esthetic areas.

HIV infection is accompanied by disturbances in lipid and glucose metabolism, which are further compounded by changes induced by antiretroviral drugs. There is increasing concern that these changes will lead to an epidemic of cardiovascular disease. Cardiovascular disease will no doubt increase, but current data indicate that the average absolute levels are likely to remain low, although patients with additional risks (smoking, hypertension, diabetes, age, family history, etc.) are certainly more susceptible. The complications of therapy need to be taken into account when deciding on the time of treatment, and reducing risk factors should become a routine aspect of the care of an HIV population that now lives longer as a result of highly active antiretroviral therapy.

Management of breast cancer is entering a phase of dramatic changes based on screening, more sophisticated therapy, and the development of “high technology” solutions through research. Appreciation of basic principles of biological behavior and therapy need current emphasis, however. By 2015 the American Cancer Society goals of 50% reduction in mortality and 25% reduction in incidence should be met and probably exceeded in breast cancer.

Mental health professionals working with codependents of sex addicts in either individual or couple therapy need to understand the issues with which codependents grapple during their early recovery process. This article outlines the first four stages of code-pendent recovery, highlighting the central themes related to each stage and addressing the treatment implications. These themes resulted from lengthy interviews with 35 recovering women and are intended to foster a dialogue to help mental health practitioners better understand the clinical issues of sexual coaddicts and the recovering couple throughout their recovery process.

Future changes in the use of Helicobacter pylori eradication therapy first will involve a decision-making process to determine which individuals require testing. Clearly, only persons who require therapy need to be diagnosed and, at present, the indications for therapy are constantly expanding. The author takes the view that everyone with H. pylori would be better off without the bacterium, but accepts that in many countries resources are inadequate to achieve this goal. Where antibiotic therapy for H. pylori fails due to a resistant organism, second treatment must include a different class of antibiotic. When a third therapy is contemplated, antibiotic sensitivity studies are usually necessary. In developing counties where reinfection with H. pylori is common, lesser goals than permanent cure might be appropriate. Thus, selected patients could have H. pylori suppressive therapy to prevent full expression of H. pylori-associated disease, or to prevent reinfection after an initial eradicative therapy. After considering all these alternatives, one must conclude that a vaccination strategy, if safe and cost effective, is the ideal future therapy.

Patients who receive curative intent therapy need adequate follow-up imaging. The purpose of imaging in these patients is to identify and manage complications related to the curative intent therapy itself, including managing postoperative complications of surgery, chemotherapy, and radiation therapy, and to measure the tumor to document response and to detect recurrences of the primary lung cancer and/or development of a new primary lung cancer early enough to allow potentially curative retreatment.

Hormone replacement therapy improves the quality of life and prolongs life for many elderly women, whether it is initiated at menopause or much later. Counseling about hormone replacement therapy should be given to all postmenopausal women. Patients should be advised that estrogen will lower the chances of death and disability from cardiovascular disease and osteoporosis. Those with low bone density or risks for cardiovascular disease, including smoking and hypertension, will benefit more than those without. Older age may predispose a woman to the carcinogenic potential of estrogen. But this should be placed in statistical perspective for the patient, with estrogen's benefit still clearly outweighing the risk. By evaluating her personal history and attitudes, the physician should help the patient decide if the potential benefit is worth either the risk or the inconvenience of side effects. Although the available data bespeak the general advantages of estrogen replacement, optimum dose, type of estrogen, time of initiation, and duration of therapy need further study in the geriatric population.

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Reduced serum insulin-like growth factor-1 (IGF-1) and hypogonadotrophic hypogonadism are common features of adult beta-thalassemia, and warrant evaluation of the growth hormone (GH)-IGF-1 axis. The aim of this study was to determine GH reserve in beta-thalassemia patients (9 females, 7 males, 15 major, 1 intermedia), age 29.3 +/- 6.9 years, BMI 21.3 +/- 1.9 kg/m2, and in 20 age, sex and BMI-matched healthy controls, using the GH-releasing hormone (GHRH)-arginine test. The associations between peak GH response and hormonal and biochemical indices were evaluated. Using BMI-related cut-off limits for peak GH response in the GHRH-arginine test, 4/16 beta-thalassemia patients had peak GH lower than 11.5 microg/l, the cut-off limit suggested for lean subjects, and were diagnosed as GH deficient (GHD). Using 9 microg/l as the cut-off limit 2/16 patients were GHD. Reduced serum IGF-1 and IGFBP-3 were present in 69% and 19% of the patients, respectively. Peak GH did not correlate with serum IGF-1, TSH, and fT4 levels or gonadal status. Neither peak GH nor IGF-1 correlated with serum ferritin. Our findings suggest that GHD is present in up to a quarter of adult beta-thalassemia patients. The clinical benefits of GH therapy need to be determined. GHD alone does not account for the high prevalence of reduced IGF-1 in adult beta-thalassemia.

The clinical success of deep brain stimulation (DBS) for treating Parkinson's disease (PD) critically depends on the quality of postoperative neurological management. Movement disorder specialists becoming involved with this therapy need to acquire new skills to adapt optimally stimulation parameters and medication after implantation of a DBS system. At first glance, the infinite number of theoretically possible parameter combinations seems to make programming a complex and time-consuming art. This article outlines a stepwise and standardized approach, reducing the possible parameter settings in DBS to a few relevant combinations. The basic programming algorithms for thalamic, subthalamic, and pallidal stimulation in PD are explained and summarized in flowcharts.

Prevention of acute rejection has been well controlled with immunosuppressive drugs. However, the long-term control of rejection is less satisfactory and the side effects of chronic usage of these drugs are far from acceptable. Thus, more imaginative options for therapy need to be explored. Gene therapy has potential promise in preserving allografts, preventing rejection and inducing tolerance. Despite this initial promise in many animal models, the translation of gene therapy to the clinical arena has been slow. This may be related in part to the deficiencies in vector development. Existing viral vectors are efficient at transducing allografts, but they induce inflammatory and pathogenic effects. Although the alternative non-viral systems are relatively innocuous, they are less efficient at gene delivery. This review systematically analyses the limitations of non-viral vector technology and the strategies that have been developed to overcome these limitations. Future development of non-viral vectors may have potential application in clinical transplantation.

The Infectious Diseases Society of America has published guidelines for the treatment of uncomplicated cystitis. Recommendations are that for healthy, adult, nonpregnant women with bacterial cystitis, 3 days of trimethoprim/ sulfamethoxazole (TMP/SMZ) or trimethoprim alone is standard therapy in those regions where less than 10% to 20% of Escherichia coli that cause such infections is resistant to TMP/SMZ. In those regions where resistance is more than 10% to 20%, the committee recommended using an oral fluoroquinolone for 3 days, and that alternatives such as nitrofurantoin for 7 days or fosfomycin as single-dose therapy need more study. These recommendations were established in the late 1990s as resistance to TMP/SMZ among uropathogens was increasing in the United States, a phenomenon earlier observed in other parts of the world. Clinicians should be alert to patients infected with possibly resistant organisms, eg, patients who have recently been hospitalized or are receiving antibiotics.

Women who seek therapy need an empathetic and enlightening means to achieve greater understanding of themselves. In group therapy experiences, the therapeutic factor of universality is a powerful source of relief to a woman who feels that her problems are painfully unique. In this setting, women will perceive their similarities with each other, in relation to their own feelings about themselves, their family, and society. While it is important for women to value each other and understand their common experiences, it is equally important for them to value and understand each other's differences. The purpose of this paper is to examine the advantages of women's groups that are ethnoculturally heterogeneous.

Immigration from developing countries to Europe has greatly increased during the last few years. Very little information is available on children who immigrated with their biological family, thus this paper deals only with children immigrating by adoption. In recent years some studies have shown an increased incidence of precocious puberty among adopted children, but information on this issue is scanty. Several hypotheses have been put forward to explain precocious puberty in adopted children, including nutritional, ethnic and/or emotional factors. Untreated precocious puberty is associated with short stature and has social and psychological consequences in addition to those related to adoption. Therefore, indications for therapy need to be carefully planned. In adopted children age estimation is a possible source of error in timing of puberty as date of birth is often missing or inaccurate. Thus each child must be carefully evaluated.

Disseminated tuberculosis is notoriously difficult to diagnose and, with the decrease in tuberculosis incidence in Australia, familiarity with its manifestations has dwindled. We describe four bacteriologically proven cases which illustrate the range of presentations and diagnostic difficulties. Surprisingly, immunosuppressive therapy need not cause rapid deterioration. Disseminated tuberculosis should be considered in any patient with multisystem illness who is at risk of tuberculosis, particularly if born overseas. In the absence of confirmatory results, a prompt therapeutic trial may be life-saving.

Although sex therapy is considered to be a relatively straight forward approach based on application of techniques, sex therapy is far more than simple application of specific techniques in the management of specific sexual dysfunctions. It requires a skilled therapist who can interpret behavioural, cognitive, supportive and educational elements in the same treatment package in an elegant way. Unfortunately sex therapy attracted many people from different disciplines who had little or no previous therapeautic experience in relationship therapy. These professionals practiced as technicians and simply adhered to the guidelines of a textbook kind of therapy. However, relationship issues must also be considered for a successful treatment. Many of the individuals and couples who present with sexual problems have relationship problems. Besides sexual and relationship problems appear interrelated in practice and thus separating the two problems is artificial. This presentation will discuss about the reasons why sex therapy and couple therapy need not remain separate and the advantages of training therapists as competent both in couple and sex therapy.

Purpose: Purpose of this research was to identify nursing activities and the time required in the psychiatric ward to provide basic knowledge for development of cost of psychiatric nursing. Methods: In this research 'a list of psychiatric nursing activities' was used to identify the issues. A list of psychiatric nursing activities was developed by a professional psychiatric nursing panel, and 138 nursing activities in 15 domains were identified. Results: The result of this research showed that the average number of work hours per duty was 515.1 minutes and the average number of minutes per patient per nurse while on duty was 35.7 minutes. Also the results showed that the nurses used the majority of their time in 'Nursing care and information management' (528.0 minutes/day, 33.6%), followed by 'communication and coordination' (209.2 minutes, 13.3%), 'safety care' (185.3 minutes, 11.8%), and 'medication' (120.9 minutes, 13.3%). Conclusion: The result of this research indicate that the number of nursing staff is insufficient for the performance of necessary therapeutic activities. Nursing practices such as counseling, activity therapy, and psychiatric treatment and specific therapy need to be developed and nursing care fees need to be included in psychiatric nursing fields.