Therapeutic apheresis in peripheral and retinal circulatory disorders

In microcirculation disorders, the therapeutic apheresis seems to have two different effects. The first, achieved after only a few sessions, is acute, consisting of drastic reduction of blood viscosity and obtained with the use of low-density lipoprotein (LDL) apheresis, rheopheresis, or fibrinogen apheresis. The second effect is long term, or chronic, and needs to be evaluated after a long course of treatment. The mechanisms underlying the chronic effect are still objects of debate and take into account the pleiotropic effects of apheresis. However, it is likely that the acute effect of apheresis mainly influences the functional components of the vascular damage, and so the derived rheological benefit might last only for a short period. The chronic effect, on the contrary, by acting on the morphological alterations of the vascular walls, requires the apheresis treatment to be prolonged for a longer period or even cycles of treatment to be programmed

A randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of neramexane in patients with moderate to severe subjective tinnitus

<p>Abstract</p> <p>Background</p> <p>Neramexane is a new substance that exhibits antagonistic properties at α₉α₁₀cholinergic nicotinic receptors and <it>N</it>-methyl-D-aspartate receptors, suggesting potential efficacy in the treatment of tinnitus.</p> <p>Methods</p> <p>A total of 431 outpatients with moderate to severe subjective tinnitus (onset 3-18 months before screening) were assigned randomly to receive either placebo or neramexane mesylate (25 mg/day, 50 mg/day and 75 mg/day) for 16 weeks, with assessment at 4-week intervals. The primary (intention-to-treat) efficacy analysis was based on the change from baseline in Week 16 in the total score of the adapted German short version of the validated Tinnitus Handicap Inventory questionnaire (THI-12).</p> <p>Results</p> <p>Compared with placebo, the largest improvement was achieved in the 50 mg/d neramexane group, followed by the 75 mg/d neramexane group. This treatment difference did not reach statistical significance at the pre-defined endpoint in Week 16 (<it>p </it>= 0.098 for 50 mg/d; <it>p </it>= 0.289 for 75 mg/d neramexane), but consistent numerical superiority of both neramexane groups compared with placebo was observed. Four weeks after the end of treatment, THI-12 scores in the 50 mg/d group were significantly better than those of the controls. Secondary efficacy variables supported this trend, with <it>p </it>values of < 0.05 for the 50 mg/d neramexane group associated with the functional-communicational subscores of the THI-12 and the assessments of tinnitus annoyance and tinnitus impact on life as measured on an 11-point Likert-like scale. No relevant changes were observed for puretone threshold, for tinnitus pitch and loudness match, or for minimum masking levels. The 25 mg/d neramexane group did not differ from placebo. Neramexane was generally well tolerated and had no relevant influence on laboratory values, electrocardiography and vital signs. Dizziness was the most common adverse event and showed a clear dose-dependence.</p> <p>Conclusions</p> <p>This study demonstrated the safety and tolerability of neramexane treatment in patients with moderate to severe tinnitus. The primary efficacy variable showed a trend towards improvement of tinnitus suffering in the medium- and high-dose neramexane groups. This finding is in line with consistent beneficial effects observed in secondary assessment variables. These results allow appropriate dose selection for further studies.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT00405886</p

Tinnitus

Tinnitus is a prevalent experience and, for those who are troubled by it, it can be debilitating. Risk factors include hearing loss, ototoxic medication, head injury and depression, and at presentation the possibility of otologic disease and of anxiety/depression should be considered. Effective drug treatments have proven elusive, though this is a vibrant theme in tinnitus research. Surgical intervention for any otological pathology associated with tinnitus may be effective for that condition, but the tinnitus may persist. Presently available treatments include the provision of hearing aids when a hearing loss is identified (even when mild or unilateral), wide band sound therapy and counselling. In some patients, cognitive behavioural therapy (CBT) is indicated though availability of tinnitus specific CBT is limited in the UK. Of these treatments the evidence base is strongest for a combination of sound therapy and CBT based counselling, though clinical trials are constrained by the heterogeneity of the tinnitus patient population. Research into mechanisms of tinnitus and effective treatments now abounds, and progress is keenly anticipated

Block-Based Discrete Wavelet Transform-Singular Value Decomposition Image Watermarking Scheme Using Human Visual System Characteristics

Digital watermarking has been suggested as a way to achieve digital protection. The aim of digital watermarking is to insert the secret data into the image without significantly affecting the visual quality. This study presents a robust block-based image watermarking scheme based on the singular value decomposition (SVD) and human visual system in the discrete wavelet transform (DWT) domain. The proposed method is considered to be a block-based scheme that utilises the entropy and edge entropy as HVS characteristics for the selection of significant blocks to embed the watermark, which is a binary watermark logo. The blocks of the lowest entropy values and edge entropy values are selected as the best regions to insert the watermark. After the first level of DWT decomposition, the SVD is performed on the low-low sub-band to modify several elements in its U matrix according to predefined conditions. The experimental results of the proposed scheme showed high imperceptibility and high robustness against all image processing attacks and several geometrical attacks using examples of standard and real images. Furthermore, the proposed scheme outperformed several previous schemes in terms of imperceptibility and robustness. The security issue is improved by encrypting a portion of the important information using Advanced Standard Encryption a key size of 192-bits (AES-192)

Kinder psychisch erkrankter Eltern in der Sozialen Arbeit : Problemlagen und Unterstützungsmöglichkeiten

Bachelor-Arbeit im Studiengang Soziale Arbeit B.A. zur Erlangung des Grades eines Bachelor of Arts