Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding:long-term randomised pragmatic trial in primary care

Background: Heavy menstrual bleeding (HMB) is a common, chronic problem affecting women and health services. However, long-term evidence on treatment in primary care is lacking. Aim: To assess the effectiveness of commencing the levonorgestrel-releasing intrauterine system (LNG-IUS) or usual medical treatments for women presenting with HMB in general practice. Design and setting: A pragmatic, multicentre, parallel, open-label, long term, randomised controlled trial in 63 primary care practices across the English Midlands. Method: In total, 571 women aged 25–50 years, with HMB were randomised to LNG-IUS or usual medical treatment (tranexamic/mefenamic acid, combined oestrogen–progestogen, or progesterone alone). The primary outcome was the patient reported Menorrhagia Multi-Attribute Scale (MMAS, measuring effect of HMB on practical difficulties, social life, psychological and physical health, and work and family life; scores from 0 to 100). Secondary outcomes included surgical intervention (endometrial ablation/hysterectomy), general quality of life, sexual activity, and safety. Results: At 5 years post-randomisation, 424 (74%) women provided data. While the difference between LNG-IUS and usual treatment groups was not significant (3.9 points; 95% confidence interval = −0.6 to 8.3; P = 0.09), MMAS scores improved significantly in both groups from baseline (mean increase, 44.9 and 43.4 points, respectively; P<0.001 for both comparisons). Rates of surgical intervention were low in both groups (surgery-free survival was 80% and 77%; hazard ratio 0.90; 95% CI = 0.62 to 1.31; P = 0.6). There was no difference in generic quality of life, sexual activity scores, or serious adverse events. Conclusion: Large improvements in symptom relief across both groups show treatment for HMB can be successfully initiated with long-term benefit and with only modest need for surgery.

Outpatient Mental Health Services in Mozambique: Use and Treatments.

To describe current outpatient mental health service use and treatments in Mozambique, the authors reviewed registry entries for 2,071 outpatient psychiatric visits at the Beira Central Hospital in Sofala Province from January 2012 to September 2014. Service use was most common for schizophrenia, followed by epilepsy, delirium, and organic behavioral disorders. Only 3% of consultations for schizophrenia were first-visit patients. Treatment seeking among women was more likely for mood and neurotic disorders and less likely for substance use disorders and epilepsy. First-generation antipsychotics, most often paired with promethazine, dominated treatment regimens. Evidence-based reforms are needed to improve identification of mood disorders and broaden care beyond severe mental disorders.

Parents’ Perception of Medication Treatments for Preschool Children with or at – risk for ADHD

Introduction: ADHD is a chronic medical condition that affects 3-7% of school-aged children. Over the last few years, there has been increased attention with children in the preschool age range. The American Academy of Pediatrics (AAP) recommends that treatment for ADHD in the preschool age range should take the form of behavior modification first, with medication only considered after behavior modification is not effective alone in treating the symptoms (AAP, 2011). However, little research has been done to examine parent perceptions of evidence-based treatment approaches for children in the preschool age range. Objective: This study sought to examine parent perceptions of psychotropic medication use for preschool age (4-6 years) children with or at-risk of ADHD. Method: Data was collected from 176 families who presented for treatment at a clinic in southeast Florida. Parents completed questionnaires about their family background, their child’s behavior, behavioral functioning, and their perceptions of medication treatment. Results: Preliminary results indicate that 50% of parents were not open to the possibility of medication, 44.6% of parents were open to the possibility of medication, and 5.4% of parents chose against medication when a physician recommended it. Results examining the extent to which severity of child behavior problems impacts parent perceptions of medication will also be presented. Conclusion: These findings demonstrate that parents of preschool children are hesitant to consider medication as a treatment option for their young children. The findings of this study are important as more and more young children are being diagnosed with ADHD each year

Modulation of CYP1A1 by PKC Inhibitors and TPA Pre-Treatments in MH1C1 Rat Hepatoma Cells Exposed to 3 -Methylcholanthrene

Cytochrome P4501A1 (CYP1A1), an enzyme known to metabolize polycyclic aromatic hydrocarbons, is regulated by the aryl hydrocarbon receptor (AhR). The involvement of protein kinase C (PKC) in the regulation of AhR signal transduction pathway, has been widely studied but the role of specific PKC isoform(s) involved in this process it is not well clarified. To study which PKC isoform(s) is implicated in the regulation of CYP1A1, in the poorly tumorigenic MH1C1 rat hepatoma cells, we examined the effects of some PKC pharmacological inhibitors, Calphostin C (CAL), Staurosporine (STA) and H7, and of 12-0-tetradecanoyl phorbol 13-acetate (TPA), a PKC activator, on basal and 3- methylcholanthrene (MC)-induced CYP1A1 protein expression and mediated ethoxyresorufin O-deethylation (EROD) activity. In parallel, the activities of PKC-α, -βI, -δ and -ε isoforms, the most expressed in MH1C1 cells, were monitored. After pre-treatment with CAL, STA and H7, the MC-induced CYP1A1 protein and EROD activity were rapidly reduced with temporal profile similar to the profile of the activity of α and β1 PKC isoforms. Moreover, TPA pre-treatment induced a biphasic effect on EROD activity, and a decline of PKC -βI and -α, in first instance, and -δ and -ε activities later on. These findings clearly show that, in MH1C1 cells, PKC is involved in CYP1A1 regulation and that α and βI classic PKC isoforms play an active role in modulating this process.

Effect of Single and Double Austenitization heat treatments on the Microstructure and Hardness of AISI D2 Tool Steel

This investigation is concerned with the study of effect of Double Austenitization (DA) and Single Austenitization (SA) heat treatment processes on microstructure and mechanical property of AISI D2type cold worked tool steel. To maximize hardness, tool steels are used in a quenched and tempered condition. This involves heating the material to the austenitizing temperature (∼850−1100 °C), quenching at an appropriate rate to form martensite, and tempering to reduce the retained austenite content and induce toughness. The merits of DA treatment isto promote dissolution of carbides at the same time proscribe grain coarsening significantly was attempted in D2 tool steel. The study has found that DA treatment has induced high hardness with insignificant growth in grains. The increase in hardness is attributed to increase in carbon content in matrix due to dissolution of carbides; whereas finer grains due to role of inclusions.

Effect of Single and Double Austenitization heat treatments on the Microstructure and Hardness of AISI D2 Tool Steel

This investigation is concerned with the study of effect of Double Austenitization (DA) and Single Austenitization (SA) heat treatment processes on microstructure and mechanical property of AISI D2type cold worked tool steel. To maximize hardness, tool steels are used in a quenched and tempered condition. This involves heating the material to the austenitizing temperature (∼850−1100 °C), quenching at an appropriate rate to form martensite, and tempering to reduce the retained austenite content and induce toughness. The merits of DA treatment isto promote dissolution of carbides at the same time proscribe grain coarsening significantly was attempted in D2 tool steel. The study has found that DA treatment has induced high hardness with insignificant growth in grains. The increase in hardness is attributed to increase in carbon content in matrix due to dissolution of carbides; whereas finer grains due to role of inclusions.

XBP1s levels are implicated in the biology and outcome of myeloma mediating different clinical outcomes to thalidomide-based treatments.

Immunoglobulin production by myeloma plasma cells depends on the unfolded protein response for protein production and folding. Recent studies have highlighted the importance of IRE1alpha and X box binding protein 1 (XBP1), key members of this pathway, in normal B-plasma cell development. We have determined the gene expression levels of IRE1alpha, XBP1, XBP1UNSPLICED (XBP1u), and XBP1SPLICED (XBP1s) in a series of patients with myeloma and correlated findings with clinical outcome. We show that IRE1alpha and XBP1 are highly expressed and that patients with low XBP1s/u ratios have a significantly better overall survival. XBP1s is an independent prognostic marker and can be used with beta2 microglobulin and t(4;14) to identify a group of patients with a poor outcome. Furthermore, we show the beneficial therapeutic effects of thalidomide in patients with low XBP1s/u ratios. This study highlights the importance of XBP1 in myeloma and its significance as an independent prognostic marker and as a predictor of thalidomide response.

Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747)

OBJECTIVE: To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC).

PATIENTS AND METHODS: Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.

RESULTS: The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively.

CONCLUSIONS: The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.

Postharvest light treatments increase skin blush in mango fruit

Skin colour is an important quality parameter that influences mango fruit marketability. The mango industry is interested in controlled induction of skin blush in mangoes. It is desirable to understand the control of anthocyanin accumulation in mango skin. Among environmental factors known to induce anthocyanin accumulation in plants, light is the most studied. Light exposure induces pigmentation in various fruits, including apple, strawberry and grape. The effect of different light qualities on skin blush in mango fruit has received relatively little attention. The objective of this study was to assess anthocyanin accumulation and blush in response to blue, red and far red light from light-emitting diodes (LEDs) as applied to harvested mango fruit skin during storage at 12°C. Except for red light, the other wavelengths induced anthocyanin accumulation and skin blush as compared to the dark control treatment. Anthocyanin concentration and a∗ values were highest in blue light exposed fruit skin. This wavelength enhanced phenylalanine ammonia lyase activity in the mango skin, which may be associated with increased pigmentation. LED light treatment did not affect other fruit quality parameters at 21 days of storage, including firmness, total soluble solids and titratable acidity. Overall, the findings suggest that postharvest treatment with blue light can induce skin blush in mango fruit, which potentially may enhance their commercial value.

Nano-silver treatments reduced bacterial colonization and biofilm formation at the stem-ends of cut gladiolus ‘Eerde’ spikes

Postharvest treatments with nano-silver (NS) alleviate bacteria-related stem blockage of some cut flowers to extend their longevity. Gladiolus (Gladiolus hybridus) is a commercially important cut flower species. For the first time, the effects of NS pulses on cut gladiolus ‘Eerde’ spikes were investigated towards reducing bacterial colonization of and biofilm formation on their stems. As compared with a deionized water (DIW) control, pulse treatments with NS at 10, 25 and 50 mg L−1 for 24 h significantly (P ≤ 0.05) prolonged the vase life of cut gladiolus spikes moved into vases containing DIW. The NS treatments enhanced floret ‘opening rate’ and ‘daily ornamental value’. Although there were no significant differences among NS treatments, a 25 mg L−1 NS pulse treatment tended to give the longest vase life and the best ‘display quality’. All NS pulse treatments significantly improved water uptake by and reduced water loss from flowering spikes, thereby delaying the loss of water balance and maintaining relative fresh weight. Fifty (50) mg L−1 NS pulse-treated cut gladiolus spikes tended to exhibit the most water uptake and highest water balance over the vase period. However, there was no significant difference between 25 and 50 mg L−1 NS pulse treatments. Observations of stem-end bacterial proliferation during the vase period on cut gladiolus spikes either with or without NS pulse treatments were performed by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). As compared to the control treatment, they revealed that the 25 mg L−1 NS pulse treatment effectively inhibited bacterial colonization and biofilm formation on the stem-end cut surface and in the xylem vessels, respectively. In vitro culture of the bacterial microflora and analysis of biofilm architecture using CLSM revealed that NS treatment restricted bacterial biofilm formation. After static culture for 24 h at 35 °C with 25 mg L−1 NS in the medium, no biofilm form or structure was evident. Rather, only limited bacterial cell number and scanty extracellular polysaccharide (EPS) material were observed. In contrast, mature bacterial biofilm architecture comprised of abundant bacteria interwoven with EPS formed in the absence of NS.

New treatments for atopic dermatitis

Atopic dermatitis now affects 15% to 20% of chil­ dren in developed countries, and prevalence in cities in developing countries undergoing rapid demographic changes is quickly following suit.1 Most cases of atopic dermatitis in a given community are mild, but children with moderate to severe disease can have continuous itching and associated loss of sleep. The social stigma of a visible skin disease can also be soul destroying for both patient and family. A few studies have suggested that some degree of prevention of the disease is possible,2 although these measures have not been taken up widely. In the absence of any treatment that is known to alter the clinical course of the disease, most treatment is aimed at reducing symp­ toms and signs. After a relative lull of almost 40 years, new drugs—tacrolimus and pimecrolimus—have appeared that offer different approaches to managing this miserable disease. Do they work? Are they safe? And how do they compare with existing treatments?