Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 72
Filtrar
2.
Childs Nerv Syst ; 36(5): 1055-1059, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31927616

RESUMO

Pediatric low-grade gliomas (LGGs) are found in approximately 1-3% of patients with childhood epilepsy that is often medically refractory. Magnetic resonance guided laser interstitial thermal therapy (MRgLITT) is a minimal access technique FDA-approved since 2007 to ablate soft tissue lesions including brain tumors and seizure foci in children. The authors describe the case of an 11-year-old boy who presented with focal right-sided seizures and was found to have a growing left insular mass determined to be a WHO grade II diffuse astrocytoma. After the initial open resection using frontotemporal craniotomy with transsylvian approach, gross total resection was achieved; however, the tumor recurred, as did the seizures. Six months postoperatively, the patient underwent laser ablation with MRgLITT for the recurrent tumor with complete removal. At both 1- and 6-months post re-operation, he has remained seizure free. MRgLITT management of LGG allows for both successfully reducing tumor burden and the amelioration of secondary seizures.


Assuntos
Neoplasias Encefálicas , Glioma , Terapia a Laser , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Criança , Liberdade , Glioma/complicações , Glioma/diagnóstico por imagem , Glioma/cirurgia , Humanos , Lasers , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Convulsões/etiologia , Convulsões/cirurgia , Resultado do Tratamento
3.
J Prev Alzheimers Dis ; 6(2): 90-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30756115

RESUMO

BACKGROUND: Randomized placebo-controlled trials in the development of disease-modifying treatments for Alzheimer's disease are typically of short duration (12-18 months), and health economic modeling requires extrapolation of treatment effects beyond the trial period. OBJECTIVES: To investigate whether observational data can be used to extrapolate data from open-label trials, we compared outcomes (cognition, function, behavior) over 36 months for patients with mild Alzheimer's disease dementia in the GERAS observational study (proxy for placebo control) with those of the mild Alzheimer's disease population on active treatment (solanezumab) in two 18-month randomized placebo-controlled trials (EXPEDITION and EXPEDITION2) and the additional 18-month open-label extension study (EXPEDITION-EXT). DESIGN AND SETTING: Analysis of longitudinal data from patients with mild Alzheimer's disease dementia in the GERAS observational study (conducted in France, Germany and the United Kingdom) and the EXPEDITION program (conducted in Europe, North America, South America, Asia and Australia). PARTICIPANTS: European and North American community-living patients, aged ≥55 years, with probable Alzheimer's disease dementia and their caregivers. Mild Alzheimer's disease dementia was defined as a Mini-Mental State Examination score of 20-26 in EXPEDITION and 21-26 in GERAS. INTERVENTION: Active treatment in both randomized placebo-controlled trials and the open-label extension study was intravenous solanezumab 400 mg every 4 weeks. Patients in GERAS were receiving treatment as part of standard care. MEASUREMENTS: Between-group differences for changes from baseline over 36 months in cognitive function, ability to perform activities of daily living, and behavioral and psychological symptoms of dementia were assessed using models stratified by propensity score. RESULTS: At baseline, patients and caregivers participating in GERAS were significantly older than those in the EXPEDITION studies, and the GERAS patient cohort had fewer years of education and a shorter time since diagnosis of Alzheimer's disease. The baseline mean Mini-Mental State Examination score of the GERAS cohort was significantly higher (indicating better cognition) than that of patients receiving placebo or active treatment in the pooled EXPEDITION studies Baseline functional ability scores were significantly lower for the GERAS cohort, indicating poorer functioning. Propensity score stratification achieved a good balance in the baseline variables between GERAS and the two EXPEDITION arms. Over 18 months, least squares mean changes from baseline in outcome measures were similar in the GERAS cohort and the pooled placebo groups from the randomized controlled trials. Also, the 18-month results for the comparison between the GERAS cohort and the pooled active treatment groups from the randomized controlled trials were generally similar to those reported for the comparison with the control group in the randomized trial. Comparison of active treatment (EXPEDITION-EXT) and observational study (GERAS, as proxy control) results over 36 months of the open-label trial showed a significantly smaller decline in activities of daily living (instrumental and basic) in the active treatment group, reflecting better functioning, but no between-group differences at 36 months for cognitive function or behavioral and psychological symptoms of dementia. CONCLUSIONS: Comparing results from clinical trials and observational studies (real-world data) may be a useful methodological approach for informing long-term outcomes in Alzheimer's disease drug development and could be used to inform health economic modeling. Further research using this methodological approach is needed.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Grupos Controle , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/enfermagem , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Cuidadores , Cognição , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
5.
Nanotechnology ; 27(22): 225502, 2016 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-27114467

RESUMO

By using coplanar waveguides, direct access to the dielectric properties of aqueous solutions of polystyrene beads with different diameters from 330 nm to 10 µm is provided. The relative variation of the transmission parameter with respect to water is monitored, ranging from [Formula: see text] obtained for a 9.5% solution with 330 nm diameter beads to ∼22% for 10 µm diameter particles at the same concentration. To highlight its applicability in biosensing, the technique was further employed to survey the clustering between biotin and streptavidin-coated beads. The transmission parameter displays a ∼50% increase for mixtures containing nine volumes of biotin and one volume of streptavidin-modified beads (4.5 ng µl(-1) of streptavidin) and reaches ∼400% higher values when equal volumes of biotin and streptavidin-coated beads (22.5 ng µl(-1) of streptavidin) were mixed.

6.
J Prev Alzheimers Dis ; 3(3): 138-144, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29205252

RESUMO

BACKGROUND: Both cognitive and functional deterioration are characteristic of the clinical progression of Alzheimer's disease (AD). OBJECTIVES: To systematically assess correlations between widely used measures of cognition and function across the spectrum of AD. DESIGN: Spearman rank correlations were calculated for cognitive and functional measures across datasets from various AD patient populations. SETTING: Post-hoc analysis from existing databases. PARTICIPANTS: Pooled data from placebo-treated patients with mild (MMSE score ≥20 and ≤26) and moderate (MMSE score ≥16 and ≤19) AD dementia from two Phase 3 solanezumab (EXPEDITION/2) and two semagecesatat (IDENTITY/2) studies and normal, late mild cognitive impairment (LMCI) and mild AD patients from the Alzheimer's Disease Neuroimaging Initiative 2-Grand Opportunity (ADNI-2/GO). Intervention (if any): Placebo (EXPEDITION/2 and IDENTITY/2 subjects). MEASUREMENTS: Cognitive and functional abilities were measured in all datasets. Data were collected at baseline and every three months for 18 months in EXPEDITION and IDENTITY studies; and at baseline, 6, 12, and 24 months in the ADNI dataset. RESULTS: The relationship of cognition and function became stronger over time as AD patients progressed from preclinical to moderate dementia disease stages, with the magnitude of correlations dependent on disease stage and the complexity of functional task. The correlations were minimal in the normal control population, but became stronger with disease progression. CONCLUSIONS: This analysis found that measures of cognition and function become more strongly correlated with disease progression from preclinical to moderate dementia across multiple datasets. These findings improve the understanding of the relationship between cognitive and functional clinical measures during the course of AD progression and how cognition and function measures relate to each other in AD clinical trials.

7.
Int J Clin Pract ; 69(9): 957-66, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25939897

RESUMO

BACKGROUND: Duloxetine has been approved in the United States, European Union and some Asian countries for the treatment of diabetic peripheral neuropathic pain (DPNP). We assessed the efficacy and safety of duloxetine (60 mg once daily) compared with placebo in Chinese patients suffering from DPNP. METHODS: This was a phase 3, multicenter, randomised, double-blind, parallel, placebo-controlled, 12-week trial of the treatment of DPNP with duloxetine. Subjects were male and female outpatients ≥ 18 years of age with DPNP, as assessed by the Michigan Neuropathy Screening Instrument, and had a rating of ≥ 4 on the Brief Pain Inventory-Modified Short Form-Severity weekly average pain item. The primary efficacy measure was the reduction in pain severity from baseline to 12 weeks, as measured by the weekly mean of 24-h average pain ratings recorded in the patient's diary. Mean changes from baseline in efficacy measures were analysed by a restricted maximum likelihood-based, mixed-effects model repeated measures approach and by analysis of covariance. RESULTS: Of the 405 patients randomised, 203 patients were assigned to duloxetine 60 mg once daily and 202 patients were assigned to placebo. Duloxetine-treated patients showed significantly greater pain relief on 24-h average pain ratings compared with placebo-treated patients each week of the 12-week study period [week 12: least squares (LS) mean change duloxetine: -2.40, placebo: -1.97; LS mean change difference (95% confidence interval) = -0.43 (-0.82, -0.04), p = 0.030]. Compared with placebo, patients treated with duloxetine experienced higher rates of nausea (p = 0.010), somnolence (p < 0.001) and asthenia (p = 0.002). CONCLUSIONS: Duloxetine-treated patients showed significantly greater pain relief compared with placebo-treated patients over the 12-week study period. Duloxetine was shown in Chinese patients to have a safety profile similar to that found in previous duloxetine trials.


Assuntos
Analgésicos/uso terapêutico , Neuropatias Diabéticas/tratamento farmacológico , Cloridrato de Duloxetina/uso terapêutico , Neuralgia/tratamento farmacológico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Adulto , Idoso , China , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estados Unidos
8.
Nat Commun ; 6: 5922, 2015 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-25557273

RESUMO

The high-rate sensitivity of nanostructured metallic materials demonstrated in the recent literature is related to the predominance of thermally activated deformation mechanisms favoured by a large density of internal interfaces. Here we report time-resolved high-resolution electron transmission microscopy creep tests on thin nanograined films using on-chip nanomechanical testing. Tests are performed on palladium, which exhibited unexpectedly large creep rates at room temperature. Despite the small 30-nm grain size, relaxation is found to be mediated by dislocation mechanisms. The dislocations interact with the growth nanotwins present in the grains, leading to a loss of coherency of twin boundaries. The density of stored dislocations first increases with applied deformation, and then decreases with time to drive additional deformation while no grain boundary mechanism is observed. This fast relaxation constitutes a key issue in the development of various micro- and nanotechnologies such as palladium membranes for hydrogen applications.

9.
Int J Clin Pract ; 68(9): 1130-40, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24837444

RESUMO

OBJECTIVE: The safety and tolerability of three treatments for diabetic peripheral neuropathic pain (DPNP) were compared. METHODS: A 12-week, randomized, open-label study confirming the non-inferiority of duloxetine (N = 138) vs. pregabalin (N = 134) and the combination of duloxetine plus gabapentin (N = 135) as the primary outcome was previously published. Patients had an inadequate pain response to a stable dose of gabapentin (≥ 900 mg/day) for ≥ 5 weeks prior to study enrolment. Data from that study were assessed in this current analysis for a detailed report of safety and tolerability. RESULTS: Completion rates did not differ significantly between the groups. Discontinuation because of adverse events was significantly greater in the duloxetine (19.6%) vs. pregabalin group (10.4%; p = 0.04); no differences emerged between the duloxetine vs. duloxetine plus gabapentin (13.3%) groups (p = 0.19) or pregabalin vs. duloxetine plus gabapentin groups (p = 0.57). Adverse event rates varied: nausea, insomnia, hyperhidrosis and decreased appetite were reported significantly more often in patients treated with duloxetine vs. patients treated with pregabalin (each p ≤ 0.01); insomnia significantly more in patients treated with duloxetine vs. duloxetine plus gabapentin (p = 0.01); peripheral oedema significantly more in patients treated with pregabalin vs. duloxetine and duloxetine plus gabapentin (p ≤ 0.001 each) and nausea, hyperhidrosis, decreased appetite and vomiting significantly more in patients treated with duloxetine plus gabapentin vs. pregabalin (each p ≤ 0.05). At end-point, weight change differed significantly among treatment groups: patients in the pregabalin group on average gained weight (1.0 ± 0.04 kg); while, patients in the duloxetine and duloxetine plus gabapentin groups on average lost weight (-2.39 ± 0.04 and -1.06 ± 0.04 kg, respectively) (pregabalin vs. duloxetine, p ≤ 0.001; pregabalin vs. duloxetine plus gabapentin, p ≤ 0.001; duloxetine vs. duloxetine plus gabapentin, p = 0.01). CONCLUSION: Duloxetine, pregabalin and duloxetine plus gabapentin were generally safe and tolerable for the treatment of DPNP.


Assuntos
Aminas/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Quimioterapia Combinada/normas , Cloridrato de Duloxetina/uso terapêutico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Pregabalina/uso terapêutico , Resultado do Tratamento , Ácido gama-Aminobutírico/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminas/efeitos adversos , Analgésicos/uso terapêutico , Ácidos Cicloexanocarboxílicos/efeitos adversos , Quimioterapia Combinada/métodos , Quimioterapia Combinada/estatística & dados numéricos , Cloridrato de Duloxetina/efeitos adversos , Feminino , Gabapentina , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/tratamento farmacológico , Medição da Dor , Doenças do Sistema Nervoso Periférico/complicações , Pregabalina/efeitos adversos , Ácido gama-Aminobutírico/efeitos adversos
10.
Rev Sci Instrum ; 84(3): 036102, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23556854

RESUMO

The tensile response of top-down fabricated sc-Si nanobeams is inferred from the fitting of stress-strain data obtained under tensile loading conditions over a large range of deformation. The testing is performed using MEMS structures consisting of two connected beams; a highly stressed silicon-nitride (SiN) beam connected to a sc-Si specimen beam. The high tensile stress component present upon the deposition of the SiN loads the sc-Si beam once the entire structure is released. The strain and stress values are extracted independently, respectively, by scanning electron microscopy inspection and vibration frequency measurement of the released tensile MEMS structures. The tensile tests are undertaken for six thicknesses to determine the dependence of the elastic response on dimensions. The Young's modulus shows a variation of 40% for thicknesses ranging from 200 to 30 nm.

11.
Small ; 9(19): 3247-51, 2013 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-23606323

RESUMO

Blue, pink, and yellow colorations appear from twisted bi-layer graphene (tBLG) when transferred to a SiO2 /Si substrate (SiO2 = 100 nm-thick). Raman and electron microscope studies reveal that these colorations appear for twist angles in the 9-15° range. Optical contrast simulations confirm that the observed colorations are related to the angle-dependent electronic properties of tBLG combined with the reflection that results from the layered structure tBLG/100 nm-thick SiO2 /Si.

12.
Int J Clin Pract ; 66(12): 1158-67, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23163495

RESUMO

AIMS: To estimate the frequency of painful physical symptoms (PPS) in elderly subjects (≥ 65 years) with major depressive disorder (MDD) in real-world clinical conditions and to establish whether PPS are associated with poor depression outcomes, including more severe depression and worse health-related quality of life (HRQoL). METHODS: Observational studies of MDD that included assessment of PPS and elderly subjects were screened. Measures of PPS were based on the Somatic Symptom Inventory (SSI) or Visual Analogue Scale (VAS). Data from a variety of depressive symptom severity and HRQoL scales were used. Analysis cohorts were based on age [aged ≥ 65 years (elderly) or < 65 years (younger)] and/or PPS status (presence or absence); five subsets were used to examine specific outcomes in matched elderly subjects. RESULTS: Data from seven studies (representing 26 countries) were collated. Of the 11,477 subjects, 14% were aged ≥ 65 years and 71% were classified as having PPS (PPS+). PPS were more frequent in elderly subjects (74% vs. 70% of younger subjects) and were positively associated with being female and Hispanic, and negatively associated with being East Asian in the elderly. The presence of PPS was associated with more severe clinical symptomatology and comparatively poorer HRQoL in elderly subjects. CONCLUSIONS: PPS, although frequent in younger MDD patients, were slightly more frequent in elderly MDD patients and associated with comparatively poorer clinical and functional outcomes. As elderly patients report somatic symptoms more readily than emotional symptoms, physicians should consider depression in addition to physical causes when PPS are present.


Assuntos
Transtorno Depressivo Maior/complicações , Dor/psicologia , Idoso , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/etnologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Dor/etnologia , Qualidade de Vida , Fatores Sexuais
13.
Rev Sci Instrum ; 83(10): 105004, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23126797

RESUMO

A stress relaxation method for freestanding thin films is developed based on an on-chip internal stress actuated microtensile testing set-up. The on-chip test structures are produced using microfabrication techniques involving cleaning, deposition, lithography, and release. After release from the substrate, the test specimens are subjected to uniaxial tension. The applied load decays with the deformation taking place during relaxation. This technique is adapted to strain rates lower than 10(-6)∕s and permits the determination of the strain rate sensitivity of very thin films. The main advantage of the technique is that the relaxation tests are simultaneously performed on thousands of specimens, pre-deformed up to different strain levels, for very long periods of time without monopolizing any external mechanical loading equipment. Proof of concept results are provided for 205-nm-thick sputtered AlSi(0.01) films and for 350-nm-thick evaporated Pd films showing unexpectedly high relaxation at room temperature.

14.
Nanotechnology ; 22(43): 435203, 2011 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-21969278

RESUMO

Hole electrical transport in a p-doped nanochannel defined between two L-shape etched trenches made on a silicon-on-insulator substrate is investigated using a TCAD-Medici simulator. We study the impact of the etched trenches' geometry and dielectric filling materials on the current-voltage characteristics of the device. Carrier accumulation on frontiers defined by the trenches causes a modulation of the hole density inside the conduction channel as the bias voltage varies and this gives rise to a diode-like characteristic. For a 1.2 µm-long channel, plots of the electric field distribution show that a nonlinear transport regime is reached at a moderate reverse and forward bias of ± 2 V. Plots of the carrier velocity along the conduction channel show that holes remain hot for a few hundreds of nm outside the nanometre-wide channel, at a bias of ± 10 V. Filling the etched trenches with a high-κ dielectric material gives rise to a lower threshold voltage, V(th). A similar decrease of V(th) is also achieved by reducing the longitudinal and/or the transverse trench width. Our simulation results provide useful design guidelines for future integrated self-switching-diode-based circuits.

15.
Int J Clin Pract ; 65(1): 73-81, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21078010

RESUMO

BACKGROUND: This study was designed to assess clinical and functional outcomes associated with switching to duloxetine treatment in patients with major depressive disorder (MDD) experiencing emotional and painful physical symptoms in their current episode. METHODS: In this 8-week, multinational, multicentre, single-arm, open-label clinical trial, 242 MDD patients were switched to duloxetine 60 mg/day after selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) treatment. The primary analysis compared mean change from baseline in Brief Pain Inventory-Modified Short Form (BPI-SF) interference score between initial responders [≥ 50% reduction from baseline on the 17-item Hamilton Depression Rating Scale (HAMD(17)) Maier subscale] and initial non-responders after 4 weeks. Initial responders continued with duloxetine 60 mg/day. Initial non-responders received duloxetine 120 mg/day for the remaining 4 weeks. Depression, pain, anxiety and functional outcomes were also compared after 8 weeks. RESULTS: BPI-SF interference decreased from baseline in initial responders (n = 108) and initial non-responders (n = 85) after 4 weeks of duloxetine treatment, with greater reductions in initial responders [BPI-SF mean difference in reduction: 1.01 (95% CI 0.42-1.61); p < 0.001]. Reductions in pain interference favouring initial responders were also apparent after 8 weeks [0.68 (95% CI: 0.03-1.33); p = 0.042]. Depression, pain, anxiety and function improved over 8 weeks across patient groups. CONCLUSIONS: Elements of core mood and pain are important residual symptoms following poor treatment response in MDD. Early improvement in these symptoms after switching to duloxetine indicated an increased chance of functional recovery.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tiofenos/uso terapêutico , Adulto , Sintomas Afetivos/tratamento farmacológico , Dor Crônica/prevenção & controle , Cloridrato de Duloxetina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Int J Clin Pract ; 64(6): 719-26, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20345508

RESUMO

OBJECTIVE: To assess the efficacy of duloxetine 60 mg/day in the prevention of depressive recurrence in patients with major depressive disorder (MDD). METHODS: Patients having at least three episodes of MDD in the past 5 years received open-label (OL) duloxetine 60-120 mg/day for up to 34 weeks. Patients meeting response criteria were then randomised to either duloxetine or placebo for up to 52 weeks of double-blind maintenance treatment. Only patients taking duloxetine 60 mg/day during the OL phase, and randomised to either duloxetine (remained on 60 mg/day dose) or placebo, were included in this post hoc analysis. The primary outcome measure was time to recurrence of a major depressive episode. The 17-item Hamilton Rating Scale for Depression (HAMD(17)) was used to evaluate depressive symptomatology. Global and physical functioning and pain were also assessed. Safety and tolerability were assessed via analysis of treatment-emergent adverse events (TEAEs), vital signs and weight. RESULTS: A total of 124 patients were randomised to duloxetine 60 mg/day (n = 64) or placebo (n = 60). Time to depressive recurrence was significantly longer in duloxetine-treated patients compared with placebo-treated patients (p = 0.001). During the double-blind maintenance phase, 31.7% of placebo-treated patients experienced a depressive recurrence compared with 12.5% of duloxetine-treated patients (p = 0.004). The HAMD(17) total score and most of its subscales as well as the Clinical Global Impression of Severity (CGI-S), significantly worsened in the placebo group compared with the duloxetine 60 mg/day group. There were no significant differences between treatment groups in TEAEs, discontinuations because of adverse events, vital signs or weight. CONCLUSIONS: Treatment with duloxetine 60 mg/day was associated with a longer time to depressive recurrence and a significantly lower recurrence rate compared with placebo.


Assuntos
Antidepressivos/administração & dosagem , Transtorno Depressivo Maior/prevenção & controle , Tiofenos/administração & dosagem , Adulto , Idoso , Análise de Variância , Antidepressivos/efeitos adversos , Método Duplo-Cego , Cloridrato de Duloxetina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Tiofenos/efeitos adversos , Resultado do Tratamento , Adulto Jovem
17.
Int J Clin Pract ; 63(7): 1041-9, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19570122

RESUMO

AIMS: Reports from non-Asian populations indicate that painful physical symptoms (PPS) are associated with poorer clinical and functional outcomes in major depressive disorder (MDD). The purpose of this study is to report comparative changes in disease severity, treatment patterns and quality of life observed in East Asian patients with MDD, with and without PPS, as assessed prospectively over a 3-month observation period. METHODS: This observational study enrolled 909 patients with MDD in psychiatric care settings in China, Hong Kong, Korea, Malaysia, Singapore and Taiwan. Patients were classified as PPS positive (PPS+) or negative (PPS-) based on mean modified Somatic Symptom Inventory scores of >or= 2 or < 2 respectively. The Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD(17)) determined depression severity; a visual analogue scale (VAS) determined pain severity; and the EuroQoL (EQ-5D) assessed well-being after 3 months observation. RESULTS: Of the 909 enrollees, 355/471 (75.4%) of PPS+ patients and 363/438 (82.9%) of PPS- patients completed the study (p = 0.006). PPS+ patients improved less than PPS- patients on depression, pain and quality of life measures during the study (HAMD(17) p < 0.001, CGI-S p < 0.001, VAS p = 0.008 and EQ-5D p = 0.004). Fewer PPS+ patients (46.5%) achieved remission compared with PPS- patients (69.4%, p < 0.001). CONCLUSION: As the presence of PPS is associated with poorer outcomes in East Asian MDD patients, clinical management should aim to address both the mental and PPS associated with MDD.


Assuntos
Transtorno Depressivo Maior/complicações , Dor/psicologia , Adolescente , Adulto , Idoso , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/etnologia , Emprego , Ásia Oriental , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Dor/etnologia , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Adulto Jovem
18.
Int J Clin Pract ; 61(8): 1337-48, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17627710

RESUMO

AIMS: This was a post hoc analysis to determine whether baseline severity of depression influenced the efficacy of duloxetine in treating major depressive disorder (MDD) and to better characterise the symptom response profile for duloxetine in patients with mild, moderate or more severe depression. METHODS: Data were pooled from four double-blind, placebo-controlled studies in which outpatients with MDD were randomised to duloxetine (60 mg/day) or placebo for 8-9 weeks. Patients were retrospectively stratified according to baseline 17-item Hamilton Depression Rating scale (HAMD17) total scores: mild=total score

Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Tiofenos/uso terapêutico , Adulto , Idoso , Estudos de Coortes , Método Duplo-Cego , Cloridrato de Duloxetina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento
19.
Int J Clin Pract ; 61(8): 1283-93, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17590215

RESUMO

AIM AND METHODS: The impact of medical comorbidity on the efficacy and tolerability of duloxetine in elderly patients with major depressive disorder (MDD) was investigated in this study. Data were obtained from a multicentre, randomised, double-blind, placebo-controlled study in 311 patients with MDD aged 65-89. The primary outcome measure was a prespecified composite cognitive score based on four cognitive tests: (i) Verbal Learning and Recall Test; (ii) Symbol Digit Substitution Test; (iii) 2-Digit Cancellation Test and (iv) Letter-Number Sequencing Test. Secondary measures included the Geriatric Depression Scale (GDS), 17-Item Hamilton Depression Scale (HAMD17), Clinical Global Impression-Severity (CGI-S) Scale, Visual Analogue Scale (VAS) for pain and 36-Item Short Form Health Survey (SF-36). Tolerability measures included adverse events reported as the reason for discontinuation and treatment-emergent adverse events (TEAEs). The consistency of the effect of duloxetine vs. placebo comparing patients with and without medical comorbidity (vascular disease, diabetes, arthritis or any of these) was investigated. RESULTS: Overall, duloxetine 60 mg/day demonstrated significantly greater improvement compared with placebo for the composite cognitive score, GDS and HAMD17 total scores, CGI-Severity, HAMD17 response and remission rates, and some of the SF-36 and VAS measures. There were few significant treatment-by-comorbidity subgroup interactions for these efficacy variables, or for adverse events reported as the reason for discontinuation and common TEAEs. CONCLUSIONS: The present analyses suggested that the efficacy of duloxetine on cognition and depression in elderly patients, and its tolerability, were not largely affected by the comorbidity status. These results further support the use of duloxetine in elderly patients with MDD.


Assuntos
Antidepressivos/uso terapêutico , Artrite/complicações , Doenças Cardiovasculares/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Dor/tratamento farmacológico , Tiofenos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/efeitos adversos , Transtorno Depressivo Maior/complicações , Método Duplo-Cego , Cloridrato de Duloxetina , Feminino , Humanos , Masculino , Dor/etiologia , Medição da Dor , Índice de Gravidade de Doença , Tiofenos/efeitos adversos , Resultado do Tratamento
20.
Biosens Bioelectron ; 22(9-10): 2199-207, 2007 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-17129721

RESUMO

Based on interdigitated aluminum electrodes covered with Al(2)O(3) and silver precipitation via biotin-antibody coupled gold nano-labels as signal enhancement, three complementary electrical methods were used and compared to detect the hybridization of target DNA for concentrations down to the 50 pM of a PCR product from cytochrome P450 2b2 gene. Human hepatic cytochrome P450 (CYP) enzymes participate in detoxification metabolism of xenobiotics. Therefore, determination of mutational status of P450 gene in a patient could have a significant impact on the choice of a medical treatment. Our three electrical extraction procedures are performed on the same interdigitated capacitive sensor lying on a passivated silicon substrate and consist in the measurement of respectively the low-frequency inter-electrodes capacitance, the high-frequency self-resonance frequency, and the equivalent MOS capacitance between the short-circuited electrodes and the backside metallization of the silicon substrate. This study is the first of its kind as it opens the way for correlation studies and noise reduction techniques based on multiple electrical measurements of the same DNA hybridization event with a single sensor.


Assuntos
Óxido de Alumínio , Alumínio , DNA/análise , DNA/isolamento & purificação , Hibridização de Ácido Nucleico , Técnicas Biossensoriais , DNA/metabolismo , Eletroquímica
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA