Monotherapy or Combination Therapy for Fibromyalgia Treatment?

Fibromyalgia is a chronic pain disease whose clinical symptomatology also includes different symptom domains: fatigue, sleep disturbances, morning stiffness, dyscognition, and psychological distress. These associated symptoms usually vary in frequency and intensity from patient to patient. Because the efficacy of monotherapy is limited, more severely affected patients frequently require drug combinations. There is, however, scarce scientific information concerning the benefits and risks of such combinations. To date, only ten studies investigating the efficacy and tolerability of two-drug combinations have been published; some of these studies are old and/or studied drugs that are now known to be of little or no interest in fibromyalgia management. Thus, when polytherapy is considered, therapeutic decisions must be based on data from monotherapy trials and a sound knowledge of the pharmacological profile of each drug. Well-designed clinical trials exploring specific drug combinations selected on the basis of potential additive or synergistic effects should be performed.     

New methods for the estimation of Takagi–Sugeno model based extended Kalman filter and its applications to optimal control for nonlinear systems

This paper describes new approaches to improve the local and global approximation (matching) and modeling capability of Takagi–Sugeno (T‐S) fuzzy model. The main aim is obtaining high function approximation accuracy and fast convergence. The main problem encountered is that T‐S identification method cannot be applied when the membership functions are overlapped by pairs. This restricts the application of the T‐S method because this type of membership function has been widely used during the last 2 decades in the stability, controller design of fuzzy systems and is popular in industrial control applications. The approach developed here can be considered as a generalized version of T‐S identification method with optimized performance in approximating nonlinear functions. We propose a noniterative method through weighting of parameters approach and an iterative algorithm by applying the extended Kalman filter, based on the same idea of parameters’ weighting. We show that the Kalman filter is an effective tool in the identification of T‐S fuzzy model. A fuzzy controller based linear quadratic regulator is proposed in order to show the effectiveness of the estimation method developed here in control applications. An illustrative example of an inverted pendulum is chosen to evaluate the robustness and remarkable performance of the proposed method locally and globally in comparison with the original T‐S model. Simulation results indicate the potential, simplicity, and generality of the algorithm. An illustrative example is chosen to evaluate the robustness. In this paper, we prove that these algorithms converge very fast, thereby making them very practical to use. Copyright © 2011 John Wiley & Sons, Ltd.     

Stability of dental implants after irradiation with an 830-nm low-level laser: a double-blind randomized clinical study

Little is known about the benefits of low-level laser therapy (LLLT) on improvement of stability of dental implants. The aim of this randomized clinical study was to assess the LLLT effect on implants stability by means of resonance frequency analysis (RFA). Thirty implants were distributed bilaterally in the posterior mandible of eight patients. At the experimental side, the implants were submitted to LLLT (830?nm, 86?mW, 92.1?J/cm², 0.25?J, 3?s/point, at 20 points), and on the control side, the irradiation was simulated (placebo). The first irradiation was performed in the immediate postoperative period, and it was repeated every 48?h in the first 14?days. The initial implant stability quotient (ISQ) of the implants was measured by means of RFA. New ISQ measurements were made after 10?days, 3, 6, 9, and 12?weeks. The initial ISQ values ranged from 65–84, with a mean of 76, undergoing a significant drop in stability from the 10th day to the 6th week in the irradiated group, and presenting a gradual increase from the 6th to the 12th week. The highest ISQ values were observed on the 10th day in the irradiated group, and the lowest in the 6th week in both groups. Under the conditions of this study, no evidence was found of any effect of LLLT on the stability of the implants when measured by RFA. Since high primary stability and good bone quality are of major relevancy for a rigid bone–implant interface, additional LLLT may have little impact macroscopically.     

Rheumatoid arthritis in Senegal: a comparison between patients coming from rural and urban areas, in an urban tertiary health care center in Senegal

Several studies have suggested that rheumatoid arthritis (RA) is uncommon in rural sub-Saharan Africa. The aim of this study is to determine the potential differences between patients with RA living in rural areas and those living in urban areas. We performed a cross-sectional study from June 2006 to May 2009. We included all patients with RA (1987 ACR criteria) seen at the Rheumatology Unit of the Le Dantec Teaching Hospital, Dakar, Senegal. We compared the main socio-demographic and clinical characteristics of patients living in rural areas to those living in urban areas. We included 180 patients in our study, of whom, 143 (79.4?%) lived in urban areas and 37 (20.6?%) in rural areas. The median age was 44?years [range 34–55] in patients from rural areas vs. 41?years [range 30–53] in patients from urban areas, without any statistical significance (p?=?0.24). Patients under the age of 60 mostly lived in urban areas (p?=?0.03). The extra-articular manifestations were significantly more frequent in patients living in rural areas (p?=?0.02). There was no statistical significance when comparing the delay in diagnosis, number of swollen joints, disease activity, hand deformities, and concentration of autoantibodies (RF and ACPA) in both populations. The percentage of patients seen from the rural areas of Senegal is low (20.6?%) compared to those seen from the urban areas. The number of extra-articular manifestations is the main difference between patients living in rural and urban areas. The role played by environmental factors seems important. Further incidence studies are needed.     

Coexistence of benign phyllodes tumor and invasive ductal carcinoma in distinct breasts: case report

This report describes a rare case of coexistence of benign phyllodes tumor, which measured 9 cm in the right breast, and invasive ductal carcinoma of 6 cm in the left breast, synchronous and independent, in a 66-year-old patient. The patient underwent a bilateral mastectomy due to the size of both lesions. Such situations are rare and usually refer to the occurrence of ductal or lobular carcinoma in situ when associated with malignant phyllodes tumors, and more often in ipsilateral breast or intra-lesional.