Browsing by Subject "therapy"
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Item An Analysis of Pancreatic Cancer(Office of the Vice Chancellor for Research, 2015-04-17) Wagle, PragatThe pancreas is extremely important in various enzymatic activities, such as the production of numerous enzymes such as insulin. Pancreatic Cancer is an extremely deadly disease, which 40,000 people of the 46,000 diagnosed each year fail to survive. It is the 12th most common type of cancer and the 4th leading cause of cancer related deaths. There are 4 stages to Pancreatic ranging from stage 1 to stage 4, where the cancer has spread to a distant organ. Pancreatic cancer is an extremely difficult to diagnose as early symptoms aren’t suggestive as many other illnesses have similar signs and symptoms. Diagnosis can be done through the use of physical examinations, ct scan, ultrasound, endoscopic ultrasound, PET scan, and most effectively a needle biopsy. Currently in development are numerous different therapies. A collective effort is being put forth to further improve current established methods to combat Pancreatic Cancer. A current four-drug chemotherapy, that had results published in May 2011 has shown a 4-month improvement using a regimen called Folfirinox. Compared to treatment with gemcitabine, which is the current therapy mainly utilized, Folfirinox showed improvement on 16 percent more patients in a phase 3 trial. Another trial with a combination of Nab-Paclitaxel and Gemcitabine was conducted against just gemcitabine. Patients with the combination showed a 1.8 months higher average survival rate than without, and showed a significantly higher survival rate through two years of 13% and 5% respectively. Overall these therapies must be reformed to be compatible with a bigger patient population. Subsequently the side effects of the treatments also need to be improved as the side effects include high risk of neutropenia. Both these treatments demonstrate a more efficient therapy and have been implemented into practice but still require improvement.Item Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack: a randomized feasibility trial(Ovid Technologies Wolters Kluwer -American Heart Association, 2010-07) Bravata, Dawn M.; Concato, John; Fried, Terri; Ranjbar, Noshene; Sadarangani, Tanesh; McClain, Vincent; Struve, Frederick; Zygmunt, Lawrence; Knight, Herbert J.; Lo, Albert; Richerson, George B.; Gorman, Mark; Williams, Linda S.; Brass, Lawrence M.; Agostini, Joseph; Mohsenin, Vahid; Roux, Francoise; Klar Yaggi, H.; Department of Medicine, IU School of MedicineBACKGROUND AND PURPOSE: Transient ischemic attack (TIA) patients are at risk of recurrent vascular events. The primary objectives were to evaluate among TIA patients the prevalence of sleep apnea and among patients with sleep apnea auto-titrating continuous positive airway pressure (auto-CPAP) adherence. The secondary objective was to describe among TIA patients with sleep apnea the recurrent vascular event rate by auto-CPAP use category. METHODS: All intervention patients received auto-CPAP for 2 nights, but only intervention patients with evidence of sleep apnea received auto-CPAP for the remainder of the 90-day period. Intervention patients received polysomnography at 90 days after TIA. Control patients received polysomnography at baseline and at 90 days. Acceptable auto-CPAP adherence was defined as >or=4 hours per night for >or=75% of nights. Vascular events included recurrent TIA, stroke, hospitalization for congestive heart failure, myocardial infarction, or death. RESULTS: We enrolled 70 acute TIA patients: 45 intervention and 25 control. The majority of patients had sleep apnea: 57% at baseline and 59% at 90 days. Among the 30 intervention patients with airflow obstruction, 12 (40%) had acceptable auto-CPAP adherence, 18 (60%) had some use, and none had no use. Three intervention patients (12%) had recurrent events compared with 1 (2%;P=0.13) control patient. The vascular event rate was highest among sleep apnea patients with no CPAP use: none, 16%;some, 5%;acceptable adherence 0% (P=0.08). CONCLUSIONS: Sleep apnea is common among acute TIA patients. It appears feasible to provide auto-CPAP in the acute TIA period. Larger studies should evaluate whether a strategy of diagnosing and treating sleep apnea can reduce recurrent vascular events after TIA.Item BP Components in Advanced CKD and the Competing Risks of Death, ESRD, and Cardiovascular Events(American Society of Nephrology (ASN), 2015-06-05) Sinha, Arjun D.; Agarwal, Rajiv; Department of Medicine, IU School of MedicineItem Clinical Islet Xenotransplantation: A Step Forward(Elsevier, 2016-10) Ekser, Burcin; Bottino, Rita; Cooper, David K. C.; Department of Surgery, IU School of MedicineItem Combination therapies prevent the neuropathic, proinflammatory characteristics of bone marrow in streptozotocin-induced diabetic rats(American Diabetes Association, 2015-02) Dominguez, James M.; Yorek, Mark A.; Grant, Maria B.; Department of Ophthalmology, IU School of MedicineWe previously showed that peripheral neuropathy of the bone marrow was associated with loss of circadian rhythmicity of stem/progenitor cell release into the circulation. Bone marrow neuropathy results in dramatic changes in hematopoiesis that lead to microvascular complications, inflammation, and reduced endothelial repair. This series of events represents early pathogenesis before development of diabetic retinopathy. In this study we characterized early alterations within the bone marrow of streptozotocin (STZ)-induced diabetic rats following treatments that prevent experimental peripheral neuropathy. We asked whether bone marrow neuropathy and the associated bone marrow pathology were reversed with treatments that prevent peripheral neuropathy. Three strategies were tested: inhibition of neutral endopeptidase, inhibition of aldose reductase plus lipoic acid supplementation, and insulin therapy with antioxidants. All strategies prevented loss of nerve conduction velocity resulting from STZ-induced diabetes and corrected the STZ-induced diabetes-associated increase of immunoreactivity of neuropeptide Y, tyrosine hydroxylase, and somatostatin. The treatments also reduced concentrations of interleukin-1β, granulocyte colony-stimulating factor, and matrix metalloproteinase 2 in STZ-induced diabetic bone marrow supernatant and decreased the expression of NADPH oxidase 2, nitric oxide synthase 2, and nuclear factor-κB1 mRNA in bone marrow progenitor cells. These therapies represent novel approaches to attenuate the diabetic phenotype within the bone marrow and may constitute an important therapeutic strategy for diabetic microvascular complications.Item Comparison of Tissue Injury from Focused Ultrasonic Propulsion of Kidney Stones Versus Extracorporeal Shock Wave Lithotripsy(Elsevier, 2014-01) Connors, Bret A.; Evan, Andrew P.; Blomgren, Philip M.; Hsi, Ryan S.; Harper, Jonathan D.; Sorensen, Mathew D.; Wang, Yak-Nam; Simon, Julianna C.; Paun, Marla; Starr, Frank; Cunitz, Bryan W.; Bailey, Michael R.; Lingeman, James E.; Department of Anatomy & Cell Biology, IU School of MedicinePurpose Focused ultrasonic propulsion is a new non-invasive technique designed to move kidney stones and stone fragments out of the urinary collecting system. However, the extent of tissue injury associated with this technique is not known. As such, we quantitated the amount of tissue injury produced by focused ultrasonic propulsion under simulated clinical treatment conditions, and under conditions of higher power or continuous duty cycles, and compared those results to SWL injury. Materials and Methods A human calcium oxalate monohydrate stone and/or nickel beads were implanted (with ureteroscopy) into 3 kidneys of live pigs (45–55 kg) and repositioned using focused ultrasonic propulsion. Additional pig kidneys were exposed to SWL level pulse intensities or continuous ultrasound exposure of 10 minutes duration (ultrasound probe either transcutaneous or on the kidney). These kidneys were compared to 6 kidneys treated with an unmodified Dornier HM3 Lithotripter (2400 shocks, 120 SWs/min and 24 kV). Histological analysis was performed to assess the volume of hemorrhagic tissue injury created by each technique (% functional renal volume, FRV). Results SWL produced a lesion of 1.56±0.45% FRV. Ultrasonic propulsion produced no detectable lesion with the simulated clinical treatment. A lesion of 0.46±0.37% FRV or 1.15±0.49% FRV could be produced if excessive treatment parameters were used while the ultrasound probe was placed on the kidney. Conclusions Focused ultrasonic propulsion produced no detectable morphological injury to the renal parenchyma when using clinical treatment parameters and produced injury comparable in size to SWL when using excessive treatment parameters.Item Complications in the first 5 years following cataract surgery in infants with and without intraocular lens implantation in the Infant Aphakia Treatment Study(Elsevier, 2014-11) Plager, David A.; Lynn, Michael J.; Buckley, Edward G.; Wilson, M. Edward; Lambert, Scott R.; Infant Aphakia Treatment Study Group; Department of Ophthalmology, IU School of MedicinePURPOSE: To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. DESIGN: Prospective randomized clinical trial. METHODS: A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. RESULTS: There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal. CONCLUSION: The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.Item Coping with physical and psychological symptoms: a qualitative study of advanced lung cancer patients and their family caregivers(Springer-Verlag, 2015-07) Mosher, Catherine E.; Ott, Mary A.; Hanna, Nasser; Jalal, Shadia I.; Champion, Victoria L.; Department of Psychology, School of SciencePURPOSE: Advanced lung cancer patients have high rates of multiple physical and psychological symptoms, and many of their family caregivers experience significant distress. However, little is known about strategies that these patients and their family caregivers employ to cope with physical and psychological symptoms. This study aimed to identify strategies for coping with various physical and psychological symptoms among advanced, symptomatic lung cancer patients and their primary family caregivers. METHODS: Patients identified their primary family caregiver. Individual semi-structured qualitative interviews were conducted with 21 advanced, symptomatic lung cancer patients and primary family caregivers. Thematic analysis of interview data was framed by stress and coping theory. RESULTS: Patients and caregivers reported maintaining a normal routine and turning to family and friends for support with symptom management, which often varied in its effectiveness. Whereas support from health-care professionals and complementary and alternative medicine were viewed favorably, reactions to Internet and in-person support groups were mixed due to the tragic nature of participants' stories. Several cognitive coping strategies were frequently reported (i.e., changing expectations, maintaining positivity, and avoiding illness-related thoughts) as well as religious coping strategies. CONCLUSIONS: Results suggest that advanced lung cancer patients and caregivers may be more receptive to cognitive and religious approaches to symptom management and less receptive to peer support. Interventions should address the perceived effectiveness of support from family and friends.Item Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study(Elsevier, 2010-12) Waitzfelder, Beth; Gerzoff, Robert B.; Karter, Andrew J.; Crystal, Stephen; Bair, Mathew J.; Ettner, Susan L.; Brown, Arleen F.; Subramanian, Usha; Lu, Shou-En; Marrero, David; Herman, William H.; Selby, Joseph V.; Dudley, R. Adams; Department of Medicine, Division of General Internal Medicine, IU School of MedicineAim The broad objective of this study was to examine multiple dimensions of depression in a large, diverse population of adults with diabetes. Specific aims were to measure the association of depression with: (1) patient characteristicsItem Cost effectiveness of telecare management for pain and depression in patients with cancer: results from a randomized trial(Elsevier, 2014-11) Choi Yoo, Sung J.; Nyman, John A.; Cheville, Andrea L.; Kroenke, Kurt; Department of Medicine, IU School of MedicineOBJECTIVE: Pain and depression are prevalent and treatable symptoms among patients with cancer, yet they are often undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial demonstrated that telecare management can improve pain and depression outcomes. This article investigates the incremental cost effectiveness of the INCPAD intervention. METHODS: The INCPAD trial was conducted in 16 community-based urban and rural oncology practices in Indiana. Of the 405 participants, 202 were randomized to the intervention group and 203 to the usual-care group. Intervention costs were determined, and effectiveness outcomes were depression-free days and quality-adjusted life years. RESULTS: The intervention group was associated with a yearly increase of 60.3 depression-free days (S.E. = 15.4; P < 0.01) and an increase of between 0.033 and 0.066 quality-adjusted life years compared to the usual care group. Total cost of the intervention per patient was US$1189, which included physician, nurse care manager and automated monitoring set-up and maintenance costs. Incremental cost per depression-free day was US$19.72, which yields a range of US$18,018 to US$36,035 per quality-adjusted life year when converted to that metric. When measured directly, the incremental cost per quality-adjusted life year ranged from US$10,826 based on the modified EQ-5D to US$73,286.92 based on the SF-12. CONCLUSION: Centralized telecare management, coupled with automated symptom monitoring, appears to be a cost effective intervention for managing pain and depression in cancer patients.