selective treatment

选择性治疗
  • 文章类型: Journal Article
    稳态氧化还原状态在生理上很重要,因此可以保持稳态。状态的变化会导致信号传导(正常应激)或氧化损伤(痛苦)。氧化应激(OS)是一个难以定量的术语,只能根据不同的生物标志物进行评估。OS的临床应用,特别是对处于氧化应激状态的人进行选择性抗氧化治疗,需要定量评估,并且由于缺乏通用的生物标志物来描述它而受到限制。此外,不同的抗氧化剂对氧化还原状态有不同的影响。因此,只要我们没有确定和量化操作系统的可能性,“识别和治疗”方法的治疗性干预措施无法评估,因此,不可能是选择性预防氧化损伤的基础。
    The steady-state redox status is physiologically important and therefore homeostatically maintained. Changes in the status result in signaling (eustress) or oxidative damage (distress). Oxidative stress (OS) is a hard-to-quantitate term that can be estimated only based on different biomarkers. Clinical application of OS, particularly for selective antioxidant treatment of people under oxidative stress, requires quantitative evaluation and is limited by the lack of universal biomarkers to describe it. Furthermore, different antioxidants have different effects on the redox state. Hence, as long as we do not have the possibility to determine and quantify OS, therapeutic interventions by the \"identify-and-treat\" approach cannot be assessed and are, therefore, not likely to be the basis for selective preventive measures against oxidative damage.
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  • 文章类型: Journal Article
    目的:我们的目的是探讨T3-4N0喉癌患者行全喉切除术或部分喉切除术后放疗的合适剂量和选择体积。
    方法:对接受局部晚期(T3-T4)和病理淋巴结阴性(N0)的鳞状细胞喉癌放疗的患者进行回顾性评估。将放射疗法应用于中位60Gy(范围54-60Gy)作为选择性局部放射疗法(±气孔)。局部治疗区域包括喉部分切除术患者的术后床+喉区,术后床只适用于全喉切除术的患者。
    结果:中位随访时间为59个月,共纳入52例患者。2年,5年,8年局部区域复发控制(LRC)为95.6%。2年和5年OS率分别为93.8%和78.9%,分别。年龄<60岁的5年OS为95.8%,60年以上56.5%。
    结论:我们的数据表明,对于T3-4N0喉癌患者,不应用选择性淋巴结照射,对术后床+造口进行局部选择性照射就足够了。
    OBJECTIVE: We aimed to investigate the appropriate postoperative radiotherapy dose and selective volume in T3-4 N0 laryngeal cancer patients treated with either total or partial laryngectomy.
    METHODS: Patients who received radiotherapy for locally advanced (T3-T4) and pathologic node-negative (N0) squamous cell laryngeal cancer were retrospectively evaluated. Radiotherapy was applied to median 60 Gy (range 54-60 Gy) as selective local radiotherapy (±stoma). The local treatment areas included postoperative bed + laryngeal area for patients with a partial laryngectomy, and the postoperative bed only for patients with total laryngectomy.
    RESULTS: The median follow-up time was 59 months and 52 patients were included. The 2‑year, 5‑year, and 8‑year locoregional recurrence controls (LRC) were 95.6%. The 2‑year and 5‑year OS rates were 93.8% and 78.9%, respectively. The 5‑year OS for age < 60 years was 95.8%, for above 60 years 56.5%.
    CONCLUSIONS: Our data suggest that local selective irradiation to the postoperative bed + stoma is enough in patients with T3-4 N0 laryngeal cancer without applying elective nodal irradiation.
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  • 文章类型: Journal Article
    Bayesian latent class models were used to estimate the test accuracy (sensitivity (Se), specificity (Sp), and predictive values (NPV and PPV)) of cow-level somatic cell counts (SCC) data, quarter-level Petrifilm® on-farm milk culture, and quarter-level standard milk bacteriology for the identification of quarters that should possibly be treated with antimicrobials at dry off in dairy cows. Data of 282 cows from 9 dairy herds in Québec, Canada, with bulk tank SCC < 250,000 cells/mL were used. Estimated median herd-prevalence of infections that should be treated was 16.2 % (95 % credibility interval (CI): 11.0-22.7). Se and Sp estimates for quarter-milk culture using Petrifilm® were 82.2 % (95 %CI: 74.0-89.5) and 62.0 % (95 %CI: 58.6-65.6), respectively. Se and Sp for quarter-milk standard bacteriology were 67.4 % (95 %CI: 55.8-81.2) and 79.6 % (95 %CI: 76.4-83.0), respectively. Se and Sp of different SCC scenarios and thresholds were estimated. For first parity cows, using only the last Dairy Herd Improvement (DHI) test SCC with a threshold of 100,000 cells/mL appeared quite accurate, with Se, Sp, PPV, NPV and reduction of antimicrobial usage of 85.6 % (95 %CI: 69.6-95.6), 86.0 % (95 %CI: 80.0-91.7), 58.0 % (95 %CI: 42.3-74.2), 96.4 % (95 %CI: 91.3-99.0), and 75.3 % (95 %CI: 70.7-79.3), respectively. For cows of ≥ 2nd parity, using only the last DHI test SCC with a threshold of 200,000 cells/mL resulted in Se, Sp, PPV, NPV and reduction of antimicrobial usage of 75.3 % (95 %CI: 55.8-87.3), 84.0 % (95 %CI: 78.8-89.3), 47.2 % (95 %CI: 32.0-63.7), 94.7 % (95 %CI: 89.0-97.6), and of 77.0 % (95 %CI: 73.3-80.3), respectively. Adding quarter-level milk culture using Petrifilm® to cows identified as unhealthy using cow-level SCC data improved the test accuracy (mainly the PPV) and further reduced the use of antimicrobials. For instance, in ≥ 2nd parity cows, using only the last DHI SCC with a threshold of 200,000 cells/mL, adding a subsequent Petrifilm® test increased the reduction from 77.0 % (95 %CI: 73.3-80.3) to 89.5 % (95 %CI: 86.7-91.8). Considering the availability of SCC data, the easiness of using just the last DHI test, and the high NPV that could be achieved, producers may consider using just the last DHI test as a potential tool to identify cows that should be treated with antimicrobials at dry off. It may be used alone or in combination with quarter-level on-farm Petrifilm® milk culture on high SCC cows to further reduce the use of antimicrobials by identifying quarters that need to be treated.
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  • 文章类型: Journal Article
    寻常型线虫被认为是马的致病性最强的线虫寄生虫。自1970年代以来,频繁的驱虫计划已将普通链球菌的患病率降低到较低水平,但是,以小株(cyathostominae)和伊维菌素耐药性的广泛苯并咪唑耐药性为代价,尤其是在马蛔虫中。为了减缓瑞典驱虫药耐药性的发展,马驱虫药于2007年制成处方,并介绍了选择性治疗原则。这意味着仅对具有高卵排泄或蠕虫感染临床症状的个体进行治疗,而不是对农场中的所有马进行全面治疗。这项研究的目的是调查瑞典在引入选择性治疗方案十年后与寻常性链球菌感染相关的患病率和危险因素。在2016年和2017年3月至6月期间,共从106个农场收集了529个粪便样本。使用基于网络的问卷来收集有关驱虫程序的信息。McMaster进行了Strongyle粪便卵计数(FEC),并通过对单个幼虫培养物的特异性PCR证明了寻常性链球菌的存在。结果采用混合逻辑分析(S.寻常患病率)或线性(FEC)回归模型,其中农场被列为随机因素。普通链球菌在个体和农场水平的总体患病率为28%和61%,分别。我们观察到,与用幼虫培养或定期驱虫补充strongyleFECs的农场相比,基于strongyleFEC的农场的寻常型链球菌感染风险增加了2.9。每年1-4次,没有事先诊断。我们发现普通链球菌的患病率和强FEC水平之间没有关联,马龄,地理区域或绞痛的迹象。在每克脱落≤150个卵的马中,寻常性链球菌的患病率为25%。因此,未经治疗的低硬FECs马可能是寻常型链球菌感染的重要来源。这可能是瑞典自1999年以来寻常型链球菌患病率增加约三倍的重要原因。然而,我们的综合结果表明,基于强组织FECs和幼虫培养的组合的选择性治疗与寻常型链球菌感染风险的增加无关.尽管如此,S.vulgaris需要持续监测,当治疗频率降低时,应仔细考虑。
    Strongylus vulgaris is considered the most pathogenic nematode parasite of the horse. Frequent deworming programs since the 1970s have reduced the prevalence of S. vulgaris to low levels, but to the price of widespread benzimidazole resistance in the small strongyles (cyathostominae) and ivermectin resistance especially in the equine roundworm Parascaris spp. To slow down the progression of anthelmintic resistance in Sweden, horse anthelmintics were made prescription only medicine in 2007 and selective therapy principles were introduced. This means that only individuals with high egg excretion or clinical signs of helminth infection were treated instead of blanket treatment of all horses on a farm. The aims of this study were to investigate the prevalence and risk factors associated with S. vulgaris infection in Sweden ten years after the introduction of a selective therapy regime. A total of 529 faecal samples from 106 farms were collected during March to June in 2016 and 2017. A web-based questionnaire was used to collect information about deworming routines. Strongyle faecal egg counts (FEC) were performed by McMaster and presence of S. vulgaris was demonstrated with a specific PCR on individual larval cultures. Results were analysed by mixed logistic (S. vulgaris prevalence) or linear (FEC) regression models, where farm was included as random factor. The overall prevalence of S. vulgaris at individual and farm levels was 28% and 61%, respectively. We observed a 2.9 increased odds risk of S. vulgaris infection on farms that based their treatment on strongyle FEC only as compared to farms that complemented strongyle FECs with larval cultures or dewormed regularly, 1-4 times per year, without prior diagnosis. We found no association between the prevalence of S. vulgaris and strongyle FEC level, horse age, geographical region or signs of colic. The prevalence of S. vulgaris was 25% in horses shedding ≤150 eggs per gram. Thus horses with low strongyle FECs that are left untreated could be an important source of S. vulgaris infection. This may be an important reason for the approximately three-fold increase in S. vulgaris prevalence since 1999 in Sweden. However, our combined results indicate that selective therapy based on a combination of strongyle FECs and larval cultivation was not associated with an increased risk of S. vulgaris infection. Still, S. vulgaris needs to be monitored continuously and should be taken into careful consideration when the treatment frequency is reduced.
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  • 文章类型: Journal Article
    BACKGROUND: Nanotechnology involves the engineering of structures on a molecular level. Nanomedicine and nano-delivery systems have been designed to deliver therapeutic agents to a target site or organ in a controlled manner, maximizing efficacy while minimizing off-target effects of the therapeutic agent administered. In both reproductive medicine and obstetrics, developing innovative therapeutics is often tempered by fears of damage to the gamete, embryo or developing foetus or of negatively impacting a woman\'s reproductive potential. Thus, nanomedicine delivery systems may provide alternative targeted intervention strategies, treating the source of the disease and minimizing long-term consequences for the mother and/or her foetus.
    UNASSIGNED: This review summarizes the current state of nanomedicine technology in reproductive medicine and obstetrics, including safety, potential applications, future directions and the hurdles for translation.
    METHODS: A comprehensive electronic literature search of PubMed and Web of Science databases was performed to identify studies published in English up until February 2020. Relevant keywords were used to obtain information regarding use of nanoparticle technology in fertility and gene therapy, early pregnancy complications (ectopic pregnancy and gestational trophoblastic disease) and obstetric complications (preeclampsia, foetal growth restriction, preterm birth and gestational diabetes) and for selective treatment of the mother or foetus. Safety of specific nanoparticles to the gamete, embryo and foetus was also investigated.
    RESULTS: Pre-clinical research in the development of nanoparticle therapeutic delivery is being undertaken in many fields of reproductive medicine. Non-hormonal-targeted nanoparticle therapy for fibroids and endometriosis may provide fertility-sparing medical management. Delivery of interventions via nanotechnology provides opportunities for gene manipulation and delivery in mammalian gametes. Targeting cytotoxic treatments to early pregnancy tissue provides an alternative approach to manage ectopic pregnancies and gestational trophoblastic disease. In pregnancy, nanotherapeutic delivery offers options to stably deliver silencing RNA and microRNA inhibitors to the placenta to regulate gene expression, opening doors to novel genetic treatments for preeclampsia and foetal growth restriction. Restricting delivery of teratogenic drugs to the maternal compartment (such as warfarin) may reduce risks to the foetus. Alternatively, targeted delivery of drugs to the foetus (such as those to treat foetal arrythmias) may minimize side effects for the mother.
    UNASSIGNED: We expect that further development of targeted therapies using nanoparticles in a reproductive setting has promise to eventually allow safe and directed treatments for conditions impacting the health and reproductive capacity of women and for the management of pregnancy and serious pregnancy complications.
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  • 文章类型: Journal Article
    The treatment of radioiodine-refractory differentiated thyroid carcinoma (rrDTC) and medullary thyroid carcinoma (MTC) remains challenging. Based on phase III clinical studies, four multi-kinase inhibitors (MKI) are approved for the treatment of progressive thyroid cancer in Germany. The indications for starting systemic treatment remain a challenge as the diseases can be stable and asymptomatic over long periods of time. In contrast, MKI treatment, which slows the disease progression but is not curative, is often associated with side effects that can impair quality of life. For this reason, an aim is to develop more specific treatments with low off-target effects. In this context selective RET kinase inhibitors represent a promising new approach, which is currently tested intensively in clinical trials, e.g. for advanced symptomatic MTC.
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  • 文章类型: Journal Article
    Strongylus vulgaris is considered the most pathogenic nematode parasite of the horse. Frequent deworming programs since the 1970s have reduced the prevalence of S. vulgaris to low levels, but to the price of widespread benzimidazole resistance in the small strongyles (cyathostominae) and ivermectin resistance especially in the equine roundworm Parascaris spp. To slow down the progression of anthelmintic resistance in Sweden, horse anthelmintics were made prescription only medicine in 2007 and selective therapy principles were introduced. This means that only individuals with high egg excretion or clinical signs of helminth infection were treated instead of blanket treatment of all horses on a farm. The aims of this study were to investigate the prevalence and risk factors associated with S. vulgaris infection in Sweden ten years after the introduction of a selective therapy regime. A total of 529 faecal samples from 106 farms were collected during March to June in 2016 and 2017. A web-based questionnaire was used to collect information about deworming routines. Strongyle faecal egg counts (FEC) were performed by McMaster and presence of S. vulgaris was demonstrated with a specific PCR on individual larval cultures. Results were analysed by mixed logistic (S. vulgaris prevalence) or linear (FEC) regression models, where farm was included as random factor. The overall prevalence of S. vulgaris at individual and farm levels was 28% and 61%, respectively. We observed a 2.9 increased odds risk of S. vulgaris infection on farms that based their treatment on strongyle FEC only as compared to farms that complemented strongyle FECs with larval cultures or dewormed regularly, 1-4 times per year, without prior diagnosis. We found no association between the prevalence of S. vulgaris and strongyle FEC level, horse age, geographical region or signs of colic. The prevalence of S. vulgaris was 25% in horses shedding ≤150 eggs per gram. Thus horses with low strongyle FECs that are left untreated could be an important source of S. vulgaris infection. This may be an important reason for the approximately three-fold increase in S. vulgaris prevalence since 1999 in Sweden. However, our combined results indicate that selective therapy based on a combination of strongyle FECs and larval cultivation was not associated with an increased risk of S. vulgaris infection. Still, S. vulgaris needs to be monitored continuously and should be taken into careful consideration when the treatment frequency is reduced.
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  • 文章类型: Journal Article
    A control strategy against Fasciola hepatica infection based on selective treatment of non-lactating animals was evaluated in four Swedish dairy herds. The study was conducted over the course of two consecutive seasons in moderately to highly F. hepatica infected herds with robotic milking, where heifers and dry cows received an oral drench with albendazole (10 mg/kg) during three visits in January, February and March in both 2017 and 2018. This resulted in an anthelmintic coverage between 38 % and 58 % of the animals. Furthermore, on each visit, the infection status of all dewormed animals along with 15 randomly selected milking cows were monitored by detection of F. hepatica coproantigens. Individual milk samples were also collected quarterly from the whole herds for measurements of individual antibody levels against the parasite using milk ELISA. In addition, individual data on milk yield and quality were collected on a monthly basis between 2016 and 2018. To further study the impact of the infection on milk production, truly F. hepatica positive and negative cows in the first lactation were identified based on the results from coproantigen and milk ELISA assays. Total F. hepatica coproantigen prevalence in the herds varied between 28 % and 85 % in the first year, and between 27 % and 68 % in the second year of the study. We found that two years of treatments resulted in a significant decrease of coproantigen-positivity especially on the two most heavily infected farms. These results were confirmed by a similar drop in within-herd prevalences obtained by milk ELISA results. The infection had a significant negative impact on milk yields in untreated F. hepatica positive cows. No consistent long-term effect was observed at the herd level probably due to the influx of animals infected before puberty and/or adult animals that were re-infected at dry-off. This is the first study of the effects of F. hepatica infection on milk yield and quality in dairy herds in Sweden.
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  • 文章类型: Journal Article
    The applications of the cold atmospheric plasma jet (CAPJ) in cancer treatment have been investigated for over a decade, focused on the effect that the CAPJ creates on cancer cells. Here we report for the first time on the impact that cells have on the CAPJ during treatment. To better understand these CAPJ-cell interactions, we analyzed the CAPJ behaviors in the presence of several normal and cancer cell lines and investigated the CAPJ selectivity. A more in-depth study of plasma self-organization patterns utilizing a model which contains a combination of normal and cancer cells reveals that the cells\' capacitance can be an important predictor of plasma jet behavior. Cancer cells can direct the jet either toward or away from normal cells, which depends on the boundary condition behind the cell colony. Both experimental and theoretical results show that a grounded copper board beneath the cell-culture dish leads to opposite CPAJ behaviors compared with a floating boundary condition. In conclusion, our findings indicate that plasma can be self-adaptive toward cancer cells, and such a feature can be manipulated. Therefore, using the permittivity difference among cell lines may help us focus plasmas upon cancer cells at the vicinity of normal tissues and maximize the selectivity of plasma treatments.
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  • 文章类型: Journal Article
    The aim of this research was to evaluate the sensitivity and specificity of the FAMACHA© (F©) system in Morada Nova ewes. The conjunctivae of 562 ewes were evaluated using the F© system. Packed cell volume (PCV) served as the gold standard for clinical F© evaluation. To calculate the sensitivity and specificity of the F© system, different criteria were adopted: animals classified as (I) F© 4 and 5 or (II) 3, 4, and 5 were considered to be anemic and animals classified as (I) F© 1, 2, and 3, or (II) 1 and 2 were considered to be non-anemic. Three standard values of PCV, namely, ≤ 19%, ≤ 18%, or ≤ 15%, were used to confirm anemia. The percentage of correct treatments was always high when the F© values 4 and 5 were used as criteria for positive tests. For all the PCV cut-off values, more animals were classified as false positives when evaluated using F© 3, 4, and 5 as criteria for a positive test and more true negative animals when evaluated using only F© 4 and 5 as criteria for a positive test. For both sets of criteria for the positive tests, few animals were classified as false negatives and true positives. Eliminating the classification of F© 3 as anemic decreased the sensitivity and increased the specificity for all the PCV cut-off values for the ewes. The F© system can be used as a reliable alternative to reduce selection pressure for anthelmintics in relation to routine non-selective blanket treatment for worm control in the Morada Nova ewes.
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