Current Issue : October - December Volume : 2018 Issue Number : 4 Articles : 5 Articles
It is a challenge to be able to prescribe the optimal initial dose ofwarfarin. There have beenmany studies focused on an efficient strategy\nto determine the optimal initial dose.Numerous clinical, genetic, and environmental factors affect thewarfarin dose response. In\npractice, it is common that the initial warfarin dose is substantially different fromthe stable maintenance dose, whichmay increase\nthe risk of bleeding or thrombosis prior to achieving the stablemaintenance dose. In order to minimize the risk of misdosing, despite\npopular warfarin dose predictionmodels in the literature which create dose predictions solely based on patients� attributes, we have\ntaken physicians� opinions towards the initial dose into consideration. The initial doses selected by clinicians, along with other\nstandard clinical factors, are used to determine an estimate of the difference between the initial dose and estimated maintenance\ndose using shrinkage methods.Theselected shrinkage method was LASSO (Least Absolute Shrinkage and Selection Operator).The\nestimated maintenance dose was more accurate than the original initial dose, the dose predicted by a linear model without involving\nthe clinicians initial dose, and the values predicted by the most commonly used model in the literature, the Gage clinical model....
Purpose. To compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT)\nin treating early T-stage nasopharyngeal carcinoma (NPC). Method. Ten patients with early T-stageNPCwho received tomotherapy\nusing simultaneously integrated boost (SIB) strategies were replanned with VMAT (RapidArc of Varian, dual-arc). Dosimetric\ncomparisons between the RapidArc plan and the HT plan included the following: (1) D98, homogeneity, and conformity of PTVs;\n(2) sparing of organs at risk (OARs); (3) delivery time andmonitor units (MUs). Results. (1) Compared with RapidArc,HT achieved\nbetter dose conformity (CI of PGTVnx + nd: 0.861 versus 0.818, P = 0.004). (2) In terms of OAR protection, RapidArc exhibited\nsignificant superiority in sparing ipsilateral optic nerve (Dmax: 27.5Gy versus 49.1Gy, P < 0.001;D2: 23.5Gy versus 48.2Gy, P < 0.001),\ncontralateral optic nerve (Dmax: 30.4Gy versus 49.2Gy, P < 0.001; D2: 26.2Gy versus 48.1Gy, P < 0.001), and optic chiasm (Dmax:\n32.8Gy versus 48.3Gy, P < 0.001; D2: 30Gy versus 47.6Gy, P < 0.001). HT demonstrated a superior ability to protect the brain stem\n(D1cc: 43.0Gy versus 45.2Gy, P = 0.012), ipsilateral temporal lobe (Dmax 64.5Gy versus 66.4 Gy, P = 0.015), contralateral temporal\nlobe (Dmax: 62.8Gy versus 65.1Gy, P = 0.001), ipsilateral lens (Dmax: 4.27Gy versus 5.24Gy, P = 0.009; D2: 4.00Gy versus 5.05Gy,\nP = 0.002; Dmean: 2.99Gy versus 4.31Gy, P < 0.001), contralateral lens (Dmax: 4.25Gy versus 5.09Gy, P = 0.047; D2: 3.91Gy versus\n4.92Gy, P = 0.005; Dmean: 2.91Gy versus 4.18Gy, P < 0.001), ipsilateral parotid (Dmean: 36.4Gy versus 41.1Gy, P = 0.002; V30Gy:\n54.8% versus 70.4%, P = 0.009), and contralateral parotid (Dmean: 33.4Gy versus 39.1Gy, P < 0.001; V30Gy: 48.2% versus 67.3%, P\n= 0.005). There were no statistically significant differences in spinal cord or pituitary protection between the RapidArc plan and the\nHT plan. (3) RapidArc achieved a much shorter delivery time (3.8 min versus 7.5 min, P < 0.001) and a lower MU (618MUs versus\n5646MUs, P < 0.001). Conclusion. Our results showthat RapidArc andHT are comparable inD98, dose homogeneity, and protection\nof the spinal cord and pituitary gland. RapidArc performs better in shortening delivery time, lowering MUs, and sparing the optic\nnerve and optic chiasm. HT is superior in dose conformity and protection of the brain stem, temporal lobe, lens, and parotid....
Micro-dosing of fine cohesive powders is the key technology in additive manufacturing\nand especially in high-potency active pharmaceutical ingredients (HPAPI). However, high accuracy\nmicro-dosing (<5 mg) of fine cohesive powder is less trivial and still remains a challenge because it is\ndifficult to eliminate the aggregation phenomena caused by the strong interparticle cohesive forces\n(in small capillaries). This paper presents a novel micro-dose method of fine cohesive powders via a\npulse inertia force system. A piezoelectric actuator is used to provide a high enough pulse inertia\nforce for a tapered glass nozzle and drive powder particles in the nozzle to be discharged from the\nnozzle orifice with the help of particle self-gravity. The nozzles with outlet diameters in the range\nof 100ââ?¬â??2000 Ã?¼m were fabricated via a glass heating process. The Ã?±-lactose monohydrate powder is\nused as the micro-dosing powder. The influences of the tapered nozzle outlet diameter, amplitude\nof the applied pulse voltage, and angle of the nozzle axis on micro-dosing mass are researched.\nThe minimum mean dose mass is 0.6 mg for a single pulse inertia force. The coefficient of variation of\ndose mass, which represents the micro-dosing stability, can be controlled below 5% when the dose\nmass is relatively small....
Objective: The clinical effectiveness of tigecycline depends on appropriate use, and PK/PD\n(pharmacokinetic/pharmacodynamic) parameters related to dose and dosing interval. Methods: In our\n600-bed university-affiliated teaching hospital, we conducted a tigecycline efficacy review over\na three-month period in 34 evaluable patients. Parameters assessed included clinical response, cure or\ntreatment failure, once daily as q12h dosing, maintenance dosing, high dose vs. standard loading\nregimens, adverse effects, and the effect of infectious disease consultation on outcomes. Results:We found\nonce daily high dose tigecycline (HDT) was highly effective in treating serious systemic infections due to\nMDR Gram-positive/negative pathogens as well as C. difficile colitis. Adverse effects were infrequent and\nlimited to mild nausea/vomiting. Once daily HDT was highly effective, and the few treatment failures\nwere related to suboptimal/split dosing regimens. Conclusion: Once daily HDT was highly effective\nwhen used to treat susceptible pathogens and when optimally dosed, i.e., 200ââ?¬â??400 mg (IV) loading dose\nÃ?â??1, followed by a once daily maintenance dose of 100ââ?¬â??200 mg (IV) q24h....
Cluster headache is a rare painful primary disorder occurring in either episodic or chronic patterns. Several authors found that the\nhypothalamus, the brain region regulating endocrine function and autonomic system, is involved in the pathophysiology of cluster\nheadache. Some authors have found in patients affected by this disease abnormality in glucose metabolism. Considering the role\nof thiamine in brain function, in energetic metabolism, and in pain modulation, we treated a patient affected by cluster headache\nwith oral high-dose thiamine. We report a 41-year-old man suffering from primary chronic cluster headache since the age of 15\nyears.The patient began oral therapy with high-dose thiamine in December 2016. Oral thiamine supplementation led to a dramatic\nimprovement of the symptoms. The therapy was effective in reversing all the symptoms of the disease. Our observation suggests\nthat a thiamine deficiency due to enzymatic abnormalities or to dysfunction of the circulation of thiamine in the intracellular space\ncould cause a neuronal selective impairment in the centers that are involved in this disease and could have an important role in the\npathogenesis of the symptoms of cluster headache....
Loading....