Treatment Outcome for Flexible Dosing Buprenorphine Maintenance Treatment

Background and objectives: Achieving the best treatment outcome with the least cost should be the goal for buprenorphine office-based treatment. Methods: We conducted an observational retrospective chart review to compare the treatment outcome for patients (n = 56) receiving high dose of buprenorphine (above 16 mg daily) and patients (n = 21) receiving moderate doses (8–16 mg daily). Results: The percentages of the first four urine drug screens (UDS) positive for opiates were significantly higher for the high-dose group than for the moderate-dose group (F = 7.93, df = 7, p < .0001). However, the percentages of the most recent four UDS positive for opiates were not statistically significant (F = .62, df = 7, p = .74). The difference in the percentages of the first and last UDS for the high-dose group showed significant reduction from admission to most recently but there was no significant difference for the moderate-dose group (t = 3.1, df = 105, p = .002 for the high-dose group and t = 1.1, df = 40, p = .27 for the moderate-dose group). Conclusions and scientific significance: Using flexible buprenorphine dosing schedule with the option of titrating the dose up to 32 mg daily may offer better treatment outcome for patients who would not respond to the lower dose range.     

Correlates of Stimulant Treatment Outcome Across Treatment Modalities

Objective: This study evaluated variables associated with stimulant use outcomes in stimulant users (N = 800) receiving care in community outpatient psychosocial or methadone maintenance treatment clinics as part of a national multi-site clinical trial. Methods: Results from the full sample were examined first, and then predictors were examined separately in the two treatment modalities. Results: A cocaine-positive urine sample at study intake was the most robust and consistent correlate of stimulant use outcome in all analyses. Psychiatric distress, social environment and employment had differential effects on outcome across modalities. Conclusions/Significance: This study confirms that intake assessments have considerable value in identifying problems to be addressed in treatment.     

Cholangiocarcinoma Treatment

Cholangiocarcinoma (CCA) is a tumor of the bile ducts that usually presents with biliary obstruction and has a poor prognosis. The treatment of CCA is challenging as the tumor is usually diagnosed late and the treatments are not very effective except when complete surgical resection is possible. In carefully selected patients, liver transplant can be a curative therapy. In the majority of cases, complete surgical resection is not possible and palliation is the mainstay of treatment. Stenting, using plastic or metallic stents, allows for biliary drainage. Photodynamic therapy plays a role in palliation and might play a role in adjuvant or neoadjuvant therapy. While radiation and chemotherapy can be beneficial, newer ablative techniques and targeted chemotherapies are promising.     

General Treatment

2011270 Anti-tumor effect of suicide gene therapy using chimeric promoter plus radiotherapy on cancer cell lines. SUN Wenjie(孫文潔),et al.Dept Radiat & Med Oncol,Zhongnan Hosp,Wuhan Univ,Wuhan 430071. Abstract:Objective To explore the synergistic anti-tumor effect of radiotherapy and horseradish peroxidase/prodrug indole-3-acetic acid(HRP/IAA) gene therapy system using chimeric hTERT promoter responsive to ionizing radiation.Methods The synthetic hTERT promoters containing four     

General Treatment

<正>2012007 Echocardiography guided coated stent-graft implantation for patients with Stanford B aortic dissection.GAO Lei(高雷),et al.Dept ECG,Instit Cardiovas Res,2nd Xiangya Hosp,Centr South Univ,     

Alternate-Day Prednisone Treatment and Treatment Maintenance in Crohn''s Disease

We have reviewed our data from 55 patients with Crohn's disease (CD) treated with alternate-day prednisone (average dose: 25 mg every other morning) between 1966 and 1989 for a mean duration of 6.6 yr. Daily divided corticosteroid doses were given to all patients with active disease that had not been responsive to supportive measures and, in almost all cases, not responsive to sulfasalazine alone. After initial remission was achieved, patients were switched to alternate-day doses. Treatment evaluations utilized global assessment and the CD activity index of Harvey and Bradshaw (CDAI-HB) shown to correlate closely with the National Cooperative Crohn's Disease Study (NCCDS) activity index (CDAI). CDAI-HB scores of 0-1 indicated no or minimal activity, whereas scores of 2-15 indicated progressive activity. With the CDAI-HB and global assessments, in agreement in all cases, 33 patients (60%) showed favorable responses with 95% confidence intervals (CI) of 46.8 to 73.2. Comparing the results with a literature-based 20% spontaneous long-term remission rate, the data are significant at p less than 0.01. Serious complications were gratifyingly low, with no observed instances of osteonecrosis. It is concluded that alternate-day prednisone treatment and treatment maintenance, with or without concomitant sulfasalazine, after conventional induction of remission with daily steroid doses, is a reasonable treatment option for patients with CD not responsive to sulfasalazine alone.     

Treatment of Chronic Myocardial Ischemia: Rationale and Treatment Options

A rational approach to the treatment of chronic myocardial ischemia requires an appreciation of the pathophysiology of coronary artery disease and the treatment options available. Any factor that causes an imbalance between myocardial oxygen supply and demand can provoke ischemia. Myocardial oxygen requirements rise with increases in heart rate, contractility, or left ventricular wall stress. Myocardial oxygen supply is determined by coronary artery flow and myocardial oxygen extraction. Anti-anginal medications are the mainstay of anti-ischemic management and act to correct the balance between myocardial supply and demand by increasing coronary blood flow, reducing myocardial oxygen requirements, or both. These medications include nitrates (which act principally by venous vasodilation, but also probably by coronary dilation), beta-blockers (which act mainly by reducing heart rate and cardiac contractility), and calcium channel blockers (which act principally by arterial and coronary vasodilation). The choice of therapy and its effectiveness depend on the underlying cause of ischemia. The complimentary mechanisms of action of these drug classes suggest that their use in combination may result in a greater reduction in myocardial oxygen demand than that achieved with monotherapy. In addition, the pharmacological actions of some of these drugs may serve to offset the undesirable side effects associated with others, for example, the reflex tachycardia produced by some calcium channel blockers may be offset by beta-blocker therapy. Finally, aspirin and lipid-lowering drugs and the potential role for anti-oxidants must also be considered in combination therapy. Invasive techniques for myocardial ischemic management, such as coronary artery bypass and coronary angioplasty, improve myocardial oxygen supply by relieving or circumventing the atherosclerotic obstruction responsible for ischemia. Surgery is the preferred technique in patients with certain medical condi tions, for example, those with triple-vessel disease, but is not recommended in patients with mild angina unless left main artery disease is present.     

Treatment of shock

Shock is a life-threatening condition, resulting from different causes, and leading to tissue hypoperfusion. Symptomatic therapy associates fluids and vasoactive agents. Vasopressor and inotropic adrenergic agents remain the most commonly used to correct hypotension and/or to increase cardiac output. These agents have different haemodynamic and metabolic profiles, but the relevance of these differences on outcome has long been challenged. Recent randomized trials have shaded some light on this issue. Dopamine and norepinephrine have been the most extensively studied. These trials raised major concerns on the use of dopamine, which was associated with tachycardia and increased arrhythmic events, and may be associated with an increased risk of death especially in the subgroup of patients with cardiogenic shock. The place of epinephrine is not well defined, this agent is associated with tachycardia, increased incidence of arrhythmic events, and undesired metabolic effects.     

谵妄的治疗

谵妄的治疗包括三方面,一是对因治疗,二是对症治疗,三是护理工作。其中对因治疗针对的是震颤谵妄、疼痛、睡眠障碍、炎症和致谵妄药物;对症治疗主要使用抗精神病药,抗精神病药中又以氟哌啶醇最常用,利培酮和奥氮平次常用;护理工作主要是加强定向、控制感觉输入、激活认知和加强运动。