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1.
Georgia M. Davis Eileen Faulds Tara Walker Debbie Vigliotti Marina Rabinovich Joi Hester Limin Peng Barbara McLean Patricia Hannon Norma Poindexter Petrena Saunders Citlalli Perez-Guzman Seema S. Tekwani Greg S. Martin Guillermo Umpierrez Shivani Agarwal Kathleen Dungan Francisco J. Pasquel 《Diabetes care》2021,44(4):1055
OBJECTIVEThe use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment and reduce potential exposures during coronavirus disease 2019 (COVID-19).RESEARCH DESIGN AND METHODSWe linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 intensive care unit.RESULTSAll nine patients required mechanical ventilation and corticosteroids. During the protocol, 75.7% of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70–180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.CONCLUSIONSA hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion. 相似文献
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Synaptic effects of parvalbumin-immunoreactive (-ir) interneurons (PVs) upon medium spiny neurons may be essential to neural processing in the striatum and, in effect, may serve as an additional feature distinguishing striatum from extended amygdala. The present immunohistochemical study in the rat was done to evaluate the distributions of PVs in the striatum and extended amygdala. Numerous PVs occupy all structures currently regarded as having a striatal composition, including the caudate-putamen, nucleus accumbens, and olfactory tubercle, as well as structures that receive outputs from these, including the globus pallidus, ventral pallidum, entopeduncular nucleus and substantia nigra reticulata. The morphologies of striatal PVs and their distribution were similar to what has been previously reported. In addition, we found that the density of larger neostriatal PVs with extensive and densely immunoreactive dendritic and local axonal arbors is greatest laterally, particularly in striatal districts with slight calbindin-ir, including the striatal patch compartment. In contrast to the situation in striatum, few PVs were observed in the central and medial divisions of the extended amygdala, including the bed nucleus of stria terminalis, interstitial nucleus of the posterior limb of the anterior commissure and central and medial nuclei of the amygdala, or in mesopontine, peribrachial and medullary structures that receive extended amygdala output. The paucity of PVs may be a characteristic feature distinguishing extended amygdala and its projection areas from striatopallidum, as well as the general character of neural processing that occurs in each. 相似文献
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Pharmacokinetics of long-acting naltrexone in subjects with mild to moderate hepatic impairment 总被引:3,自引:0,他引:3
Turncliff RZ Dunbar JL Dong Q Silverman BL Ehrich EW Dilzer SC Lasseter KC 《Journal of clinical pharmacology》2005,45(11):1259-1267
Long-acting naltrexone is an extended-release formulation developed with the goal of continuous naltrexone exposure for 1 month for the treatment of alcohol dependence. The influence of mild and moderate hepatic impairment on naltrexone pharmacokinetics following long-acting naltrexone 190-mg administration was assessed. Subjects with mild (Child-Pugh grade A) and moderate (Child-Pugh grade B) hepatic impairment (n = 6 per group) and matched control subjects (n = 13) were enrolled. Naltrexone and 6beta-naltrexol concentrations were determined over a period of 63 days following a single intramuscular dose. Naltrexone and 6beta-naltrexol concentrations were detected in all subjects through 28 days. Total exposure (AUC(0-infinity)) of naltrexone and 6beta-naltrexol was similar across all groups. The long apparent half-lives of naltrexone and 6beta-naltrexol (5-8 days) were attributed to the slow release of naltrexone (long-acting naltrexone exhibits absorption rate-limited elimination or "flip-flop" kinetics); elimination was not altered in subjects with hepatic impairment. Based on pharmacokinetic considerations, the dose of long-acting naltrexone does not need to be adjusted in patients with mild or moderate hepatic impairment. 相似文献
4.
Preserving fertility after cancer 总被引:6,自引:0,他引:6
Simon B Lee SJ Partridge AH Runowicz CD 《CA: a cancer journal for clinicians》2005,55(4):211-28; quiz 263-4
In this review, the reproductive impact of treatments for several common cancers and options to maintain fertility in women and men undergoing treatment for these cancers will be discussed. The options available to any particular cancer survivor will depend on her or his age at the time of diagnosis and treatment, cancer type and primary site, stage, and type of treatment. 相似文献
5.
Ennis WJ Foremann P Mozen N Massey J Conner-Kerr T Meneses P 《Ostomy/wound management》2005,51(8):24-39
An estimated 15% of patients with diabetes will develop a foot ulcer sometime in their life, making them 30 to 40 times more likely to undergo amputation due to a non-healing foot ulcer than the non-diabetic population. To determine the safety and efficacy of a new, non-contact, kilohertz ultrasound therapy for the healing of recalcitrant diabetic foot ulcers - as well as to evaluate the impact on total closure and quantitative bacterial cultures and the effect on healing of various levels of sharp/surgical debridement - a randomized, double-blinded, sham-controlled, multicenter study was conducted in hospital-based and private wound care clinics. Patients (55 met criteria for efficacy analysis) received standard of care, which included products that provide a moist environment, offloading diabetic shoes and socks, debridement, wound evaluation, and measurement. The "therapy" was either active 40 KHz ultrasound delivered by a saline mist or a "sham device" which delivered a saline mist without the use of ultrasound. After 12 weeks of care, the proportion of wounds healed (defined as complete epithelialization without drainage) in the active ultrasound therapy device group was significantly higher than that in the sham control group (40.7% versus 14.3%, P = 0.0366, Fisher's exact test). The ultrasound treatment was easy to use and no difference in the number and type of adverse events between the two treatment groups was noted. Of interest, wounds were debrided at baseline followed by a quantitative culture biopsy. The results of these cultures demonstrated a significant bioburden (greater than 10(5)) in the majority of cases, despite a lack of clinical signs of infection. Compared to control, this therapeutic modality was found to increase the healing rate of recalcitrant, diabetic foot ulcers. 相似文献
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Dunbar JL Turncliff RZ Dong Q Silverman BL Ehrich EW Lasseter KC 《Alcoholism, clinical and experimental research》2006,30(3):480-490
BACKGROUND: Oral naltrexone is effective in the treatment of alcohol dependence; however, a major limitation of its clinical utility is poor patient adherence to the daily dosing schedule. A biodegradable, long-acting naltrexone microsphere formulation was developed to achieve continuous naltrexone exposure for 1 month in the treatment of alcohol dependence. METHODS: The single- and multiple-dose safety and pharmacokinetics of a long-acting naltrexone microsphere preparation were evaluated in healthy subjects. One group of subjects (n = 28) received a single dose of oral naltrexone 50 mg followed by a single gluteal intramuscular (IM) injection of long-acting naltrexone 190 or 380 mg or placebo. A different group of subjects (n = 14) received oral naltrexone 50 mg daily for 5 days, followed by IM long-acting naltrexone 380 mg or placebo every 28 days for a total of 4 doses. A 7-day washout period separated oral and IM administrations. Blood samples were collected to determine plasma concentrations of naltrexone and the primary metabolite, 6beta-naltrexol. RESULTS: After a single IM injection of long-acting naltrexone 380 mg, naltrexone plasma concentrations were measurable in all subjects for at least 31 days postdose. The pharmacokinetics were proportional to the dose and multiple dose observations were consistent with single dose observations. Mean apparent elimination half-lives for naltrexone and 6beta-naltrexol ranged from 5 to 7 days. Exposure to 6beta-naltrexol was reduced with IM injection compared with that oral administration. No serious adverse events occurred. CONCLUSIONS: This study demonstrated that the long-acting naltrexone formulation was well tolerated, displayed predictable pharmacokinetics, and resulted in no meaningful drug accumulation upon multiple dosing. Intramuscular administration avoids first-pass metabolism and changes the exposure ratio of 6beta-naltrexol to naltrexone compared with oral administration. By providing continuous exposure to naltrexone for several weeks following IM injection, this long-acting naltrexone formulation may offer therapeutic benefit to those patients who experience difficulty adhering to the daily administration schedule necessitated by oral naltrexone therapy. 相似文献
8.
Susan M. O'Brien John C. Byrd Peter Hillmen Steven Coutre Jennifer R. Brown Paul M. Barr Jacqueline C. Barrientos Stephen Devereux Tadeusz Robak Nishitha M. Reddy Thomas J. Kipps Alessandra Tedeschi Florence Cymbalista Paolo Ghia Stephen Chang Joi Ninomoto Danelle F. James Jan A. Burger 《American journal of hematology》2019,94(5):554-562
The efficacy of ibrutinib has been demonstrated in patients with chronic lymphocytic leukemia (CLL), including as first-line therapy. However, outcomes after ibrutinib discontinuation have previously been limited to higher-risk populations with relapsed/refractory (R/R) disease. The objective of this study was to evaluate outcomes of ibrutinib-treated patients based on prior lines of therapy, including after ibrutinib discontinuation. Data were analyzed from two multicenter phase 3 studies of single-agent ibrutinib: RESONATE (PCYC-1112) in patients with R/R CLL and RESONATE-2 (PCYC-1115) in patients with treatment-naive (TN) CLL without del(17p). This integrated analysis included 271 ibrutinib-treated non-del(17p) patients with CLL (136 TN and 135 R/R). Median progression-free survival (PFS) was not reached for subgroups with 0 and 1/2 prior therapies but was 40.6 months for patients with ≥3 therapies (median follow-up: TN, 36 months; R/R, 44 months). Median overall survival (OS) was not reached in any subgroup. Overall response rate (ORR) was 92% in TN and 92% in R/R, with depth of response increasing over time. Adverse events (AEs) and ibrutinib discontinuation due to AEs were similar between patient groups. Most patients (64%) remain on treatment. OS following discontinuation was 9.3 months in R/R patients (median follow-up 18 months, n = 51) and was not reached in TN patients (median follow-up 10 months, n = 30). In this integrated analysis, ibrutinib was associated with favorable PFS and OS, and high ORR regardless of prior therapies in patients with CLL. The best outcomes following ibrutinib discontinuation were for patients receiving ibrutinib in earlier lines of therapy. 相似文献
9.
Koopman RJ Kochendorfer KM Moore JL Mehr DR Wakefield DS Yadamsuren B Coberly JS Kruse RL Wakefield BJ Belden JL 《Annals of family medicine》2011,9(5):398-405