Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States

Aliment Pharmacol Ther 2011; 33: 149–159Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients.To describe frequency and perceived effectiveness of non-analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres.Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians.Oral PERT was commonly used (70%), more frequently in the presence of exocrine insufficiency (EI) (88% vs. 61%, P  < 0.001) and pain (74% vs. 59%, P  < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95% CI 2.87–9.18), constant (OR 3.42, 95% CI 1.93–6.04) or intermittent pain (OR 1.98, 95% CI 1.14–3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95% CI 1.36–3.42). AO were tried less often (14%) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25% vs. 4%, P  = 0.03). Other therapies were infrequently used (CPB – 5%, octreotide – 7%) with efficacy generally <50%.Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79114/1/j.1365-2036.2010.04491.x.pd

The progestational and androgenic properties of medroxyprogesterone acetate: gene regulatory overlap with dihydrotestosterone in breast cancer cells

INTRODUCTION: Medroxyprogesterone acetate (MPA), the major progestin used for oral contraception and hormone replacement therapy, has been implicated in increased breast cancer risk. Is this risk due to its progestational or androgenic properties? To address this, we assessed the transcriptional effects of MPA as compared with those of progesterone and dihydrotestosterone (DHT) in human breast cancer cells. METHOD: A new progesterone receptor-negative, androgen receptor-positive human breast cancer cell line, designated Y-AR, was engineered and characterized. Transcription assays using a synthetic promoter/reporter construct, as well as endogenous gene expression profiling comparing progesterone, MPA and DHT, were performed in cells either lacking or containing progesterone receptor and/or androgen receptor. RESULTS: In progesterone receptor-positive cells, MPA was found to be an effective progestin through both progesterone receptor isoforms in transient transcription assays. Interestingly, DHT signaled through progesterone receptor type B. Expression profiling of endogenous progesterone receptor-regulated genes comparing progesterone and MPA suggested that although MPA may be a somewhat more potent progestin than progesterone, it is qualitatively similar to progesterone. To address effects of MPA through androgen receptor, expression profiling was performed comparing progesterone, MPA and DHT using Y-AR cells. These studies showed extensive gene regulatory overlap between DHT and MPA through androgen receptor and none with progesterone. Interestingly, there was no difference between pharmacological MPA and physiological MPA, suggesting that high-dose therapeutic MPA may be superfluous. CONCLUSION: Our comparison of the gene regulatory profiles of MPA and progesterone suggests that, for physiologic hormone replacement therapy, the actions of MPA do not mimic those of endogenous progesterone alone. Clinically, the complex pharmacology of MPA not only influences its side-effect profile; but it is also possible that the increased breast cancer risk and/or the therapeutic efficacy of MPA in cancer treatment is in part mediated by androgen receptor

Experimenting with the Identity (xy)z = y(zx)

An experiment with the nonassociative algebra program Albert led to the discovery of the following surprising theorem. Let G be a groupoid satisfying the identity (xy)z = y(zx). Then for products in G involving at least five elements, all factors commute and associate. A corollary is that any semiprime ring satisfying this identity must be commutative and associative, generalizing a known result of Chen. Key words: identity, groupoid, ring. 1 Introduction The nonassociative algebra program Albert, (Jacobs, Muddana and Offutt, 1993) has recently provided insight that has led to several interesting theorems on commutativity and associativity (Hentzel and Jacobs, 1992; Hentzel, Jacobs and Kleinfeld,1993). These papers, along with the present paper, provide a growing body of evidence that computational experiments can suggest interesting conjectures in abstract algebra that can then be proven by conventional methods. The results of this paper were motivated by experiments with the i..

A prospective study on role of PET-CT in the evaluation of lung masses in a tertiary care center

Background: Lung cancer is a leading cause of death in both men and women worldwide. For the past decades, Computed Tomography (CT) has been the gold standard imaging method in oncology. It has been used for initial staging, tumor evaluation after treatment, and follow-up of patients with cancer. The PET-CT scanners are essentially full ring coincidence detectors, the P.E.T. portion, physically mounted together with CT systems of various types. AIM: To study diagnostic role and accuracy of PET-CT in evaluating lung masses in our study population. Material &amp; Methods: Study Design: Prospective cross-sectional study , Study area: The study was done in the Department of Radiodiagnosis &amp; Dept.of.Nuclear medicine, Yashoda Hospital, Hyderabad. , Study Period: 1st Feb. 2011 to 30th June 2011. , Study population: patients who were recommended and referred for the evaluation of lung masses detected on chest x-ray or by CT., Sample size: All the patients who were referred for lung masses evaluation, within the study period. Samplingmethod: Purpose or convenient sampling method. Study tools: The machine used for this study is Siemens biograph sensation 16. Ethical consideration: Institutional Ethical committee permission was taken prior to the commencement of the study. Data collection procedure: After obtaining institutional Ethical clearance, the purpose of the study was explained to the patients and their consent was taken in this regard. Observations &amp; Results: The mean and SD of age of the study population was 61.233 ± 10.101. Out of 30 patients, 10 (33%) patients were females and 20 (67%) patients were males. Conclusion: PET CT is sensitive for detecting sub clinical adenopathy and osseous involvement

A Comaparitive Study on MSCT Coronary Angiographywith Conventional Coronary Angiography in Diadgnosis of Coronary Artery Disease in A Tertiary Care Center

Background: The evolution of multi slice computed tomography (MSCT) in recent years has generated interest in its ability to detect the extent of obstructive CAD. The use of high-speed tube rotation, coupled with simultaneous acquisition of multiple slices and fast post processing imaging software has created the opportunity to acquire high-quality images of the entire heart within one breath-hold. Aim: To evaluate the diagnostic accuracy between dual source CT coronary angiography and invasive catheter coronary angiography with respect to site and degree of stenosis. Material &amp; Methods:Study Design: Prospective comparative study. Study area: The study was done in the Department of Radiodiagnosis, Yashoda Hospital, Hyderabad. Study Period: 1st Feb. 2010 to 30th June 2010. Study population: patients who were recommended and referred for angiographic evaluation of suspected CAD by the Department of Cardiology. Sampling method: Purpose or convenient sampling method. Study tools: MSCT scan protocol, coronary angiography. Statistical analysis: The diagnostic performance of coronary angiography by MSCT for detecting obstructive CAD was compared to catheter angiography. The results were calculated as the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the investigation. Results: Out of 33 patients, 11 (33%) patients were females and 22 (67%) patients were males. The age of the study subjects ranged between 28 years to 80 years. In our study, most 27(81.8%)of the study population were having right dominant circulation, followed by 3 (9.09%) in left dominant circulation and remaining 3 (9.09%) were presented with codominance circulation

A Computer Algebra System for Nonassociative Identities

this paper is to describe an initial attempt at building a specialized, but useful, system for doing nonassociative algebra. We should remark that the application of computers to nonassociative algebra is not new. An example of very early work is by Kleinfeld [10], and two books [2, 12] contain many papers on such work. However these computer solutions have usually been aimed at solving a unique problem with a very particular solution. Most often, the resulting program could not be easily reused for other similar problems. Our system is called Albert. In this paper we will describe its capabilities, briefly discuss its implementation, and then discuss some typical computations that Albert has performed

Blood urea nitrogen in the early assessment of acute pancreatitis: an international validation study

Item does not contain fulltextBACKGROUND: Objective assessment of acute pancreatitis (AP) is critical to help guide resuscitation efforts. Herein we (1) validate serial blood urea nitrogen (BUN) measurement for early prediction of mortality and (2) develop an objective BUN-based approach to early assessment in AP. METHODS: We performed a secondary analysis of 3 prospective AP cohort studies: Brigham and Women's Hospital (BWH), June 2005 through May 2009; the Dutch Pancreatitis Study Group (DPSG), March 2004 through March 2007; and the University of Pittsburgh Medical Center (UPMC), June 2003 through September 2007. Meta-analysis and stratified multivariate logistic regression adjusted for age, sex, and creatinine levels were calculated to determine risk of mortality associated with elevated BUN level at admission and rise in BUN level at 24 hours. The accuracy of the BUN measurements was determined by area under the receiver operating characteristic curve (AUC) analysis compared with serum creatinine measurement and APACHE II score. A BUN-based assessment algorithm was derived on BWH data and validated on the DPSG and UPMC cohorts. RESULTS: A total of 1043 AP cases were included in analysis. In pooled analysis, a BUN level of 20 mg/dL or higher was associated with an odds ratio (OR) of 4.6 (95% confidence interval [CI], 2.5-8.3) for mortality. Any rise in BUN level at 24 hours was associated with an OR of 4.3 (95% CI, 2.3-7.9) for death. Accuracy of serial BUN measurement (AUC, 0.82-0.91) was comparable to that of the APACHE II score (AUC, 0.72-0.92) in each of the cohorts. A BUN-based assessment algorithm identified patients at increased risk for mortality during the initial 24 hours of hospitalization. CONCLUSIONS: We have confirmed the accuracy of BUN measurement for early prediction of mortality in AP and developed an algorithm that may assist physicians in their early resuscitation efforts