The primary objective of this study was to evaluate the outcome of patients treated with high-dose chemo-/radiotherapy or high-dose chemotherapy and autologous stem-cell transplant (ASCT) for ...relapsed, refractory, or poor-risk intermediate-grade (IG) and high-grade (HG) non-Hodgkin's lymphoma (NHL). The secondary objectives were to determine prognostic factors for relapse and survival. Between February 1987 and August 1998, 264 patients, 169 (64%) IG and 95 (36%) HG, underwent high-dose therapy and ASCT at City of Hope National Medical Center (COHNMC). There were 157 (59%) males and 107 (41%) females with a median age of 44 years (range, 5–69 years). The median number of prior chemotherapy regimens was 2 (range, 1–4), and 71 (27%) had received prior radiation as part of induction or as salvage therapy. The median time from diagnosis to ASCT was 10.8 months (range, 3–158 months). Ninety-four patients (36%) underwent transplantation in first complete/partial remission (CR/PR), 40 (15%) in induction failure, and 130 (49%) in relapse or subsequent remission. Two preparative regimens were used: total body irradiation/high-dose etoposide/cyclophosphamide (TBI/VP/CY) in 208 patients (79%) and carmustine/etoposide/cyclophosphamide (BCNU/VP/CY) in 56 patients (21%). One hundred sixty-three patients (62%) received peripheral blood stem cells (PBSC) and 101 (38%) received bone marrow (BM) alone or BM plus PBSC. At a median follow-up of 4.43 years for surviving patients (range, 1–12.8 years), the 5-year Kaplan-Meier estimates of probability of overall survival (OS), progression-free survival (PFS), and relapse for all patients are 55% (95% confidence interval CI: 49%–61%), 47% (95% CI: 40%–53%), and 47% (95% CI: 40%–54%), respectively. There were 27 deaths (10%) from nonrelapse mortality, including seven (3%) patients who developed second malignancies (five with myelodysplasia/acute myelogenous leukemia and two with solid tumors). By stepwise Cox regression analysis, disease status at ASCT was the only prognostic factor that predicted for both relapse and survival. The 5-year probability of PFS for patients transplanted in first CR/PR was 73% (95% CI: 62%–81%) as compared to 30% (95% CI: 16%– 45%) for induction failure and 34% (95% CI: 26%–42%) for relapsed patients. Our results further support the role of high-dose therapy and ASCT during first CR/PR for patients with poor-risk intermediate- and high-grade NHL. Early transplant is recommended for patients failing initial induction therapy or relapsing after chemotherapy-induced remission. Relapse continues to be the most common cause of treatment failure. An alternative approach to prevent relapse, the incorporation of radioimmunotherapy into the high-dose regimen, is being investigated. The development of a second malignancy is a serious complication of high-dose therapy, which requires close surveillance.
Numerous diseases such as cancer, diabetes, cardiovascular, neurodegenerative diseases, etc. are linked with overproduction of reactive oxygen species (ROS) and oxidative stress. Apigenin ...(5,7,4′‐trihydroxyflavone) is a widely distributed flavonoid, responsible for antioxidant potential and chelating redox active metals. Being present as glycosides or polymers, the apigenin degrades to variable amount in the digestive tract; during processing, its activity is also reduced due to high temperature or Fe/Cu addition. Although its metabolism remains elusive, enteric absorption occurs sufficiently to reduce plasma indices of oxidant status. Delayed clearance in plasma and slow liver decomposition enhance its systematic bioavailability. Antioxidant mechanism of apigenin includes: oxidant enzymes inhibition, modulation of redox signaling pathways (NF‐kB, Nrf2, MAPK, and P13/Akt), reinforcing enzymatic and nonenzymatic antioxidant, metal chelation, and free radical scavenging. DPPH, ORAC, ABTS, and FRAP are the major in vitro methods for determining the antioxidant potential of apigenin, whereas its protective effects in whole and living cells of animals are examined using in vivo studies. Due to limited information on antioxidant potential of apigenin, its in vitro and in vivo antioxidant effects are, therefore, discussed with action mechanism and interaction with the signaling pathways. This paper concludes that apigenin is a potent antioxidant compound to overcome the difficulties related to oxidative stress and other chronic diseases.
4D CAD models that integrate physical 3D elements with time, have been used to visualize construction processes in several projects worldwide. 4D models have been used and have been shown to have ...benefits over processes that span the entire lifecycle of a project such as collaboration with stakeholders, making design decisions, assessing project constructability, identifying spatial conflicts in construction and so on. Despite these benefits, several organizational and project-specific barriers have hindered the widespread adoption of 4D CAD. In order to reconcile the theoretical benefits of 4D models with the practical difficulties faced in implementation, there is an urgent need to explore the
implementation of 4D models on construction sites as well as the
perceptions of intended users/beneficiaries towards this implementation. This paper aims to address this need and contribute to our understanding of how 4D models must be introduced, positioned and implemented on construction sites, so as to maximize both their acceptability and their usefulness. We describe two 4D models of infrastructure projects and two 4D models of commercial projects that have been built and implemented. Through a process of structured and unstructured interviewing the paper gauges the response of project participants across various organizational levels on each of these projects as to the usefulness of 4D in project planning and control. Through qualitative and statistical analysis of the data we establish that 4D CAD is likely to be most beneficial in the project shaping or planning stage and in the construction stage. In the project shaping stage, 4D CAD is likely to be particularly useful in communicating construction plans and processes to clients, while during the construction phase, 4D CAD is likely to be particularly useful in comparing the constructability of work methods visually in order to detect conflicts or clashes, and as a visual tool for contractors, clients, subcontractors and vendors to review and plan project progress. Further, upper management and site workers are more likely to use and derive benefits from the visualization of processes using 4D given their lack of site related knowledge or skills, while construction professionals who are more construction-savvy are more likely to appreciate and benefit from the analytical and planning aids that 4D simulations provide during the construction phase. However, it is likely that despite these benefits 4D CAD models might not diffuse through the construction industry unless 4D modelling and analysis is integrated into existing project planning approaches. The paper concludes with a brief discussion on future 4D software development that seeks to bring about such integration and leverages the benefits of 4D CAD to bring about improved operational efficiencies on construction sites.
Dermatomyositis (DM) is a systemic autoimmune disease that primarily affects the skin and muscles. The hallmark skin manifestation is a violaceous rash on the face, neck, shoulders, upper chest, and ...extensor surfaces of the arms and legs, which is often accompanied by edema and can be exacerbated by exposure to sunlight. Generalized limb edema and dysphagia are rare presentations of dermatomyositis. Here we present a case of a 69-year-old woman presenting with generalized limb swelling, periorbital swelling, and dysphagia which was diagnosed as dermatomyositis based on a combination of clinical, laboratory, and imaging findings. The patient had an absence of complaints of limb weakness and a predominance of complaints of edema and dysphagia which posed a diagnostic challenge. The patient was treated with high-dose steroids and immunosuppressive therapy, leading to a significant improvement in her symptoms. Edematous dermatomyositis has been associated with underlying malignancy in 25% of the cases and this warrants close follow-up and malignancy screening for such patients. In some cases, subcutaneous edema might be the only manifestation of the disease. This case underscores the importance of recognizing DM as a potential differential diagnosis in patients presenting with generalized edema and dysphagia, particularly in the initial absence of classic skin findings. This rare presentation of dermatomyositis may be a hallmark of a severe form of the disease and requires prompt recognition and aggressive treatment.
CONTEXT: The outbreak and spread of severe acute respiratory syndrome coronavirus 2 has led to a global exigency of colossal and monstrous proportions in terms of public health and economic crisis. ...Till date, no pharmaceutical agent is known to manage in terms of prevention and treatment of coronavirus disease 2019 (COVID-19), the disease caused by a novel virus.
AIMS: The aim of the present work was to understand the underlying disease profile and dynamics that could provide relevant inputs and insight into pathophysiology and prevent further spread and evolve management strategies of COVID-19 patients from data-driven techniques.
SETTINGS AND DESIGN: A retrospective observational descriptive study was conducted on 29 COVID-19 patients admitted at a premier medical institution of North India in the months of February and March 2020.
METHODS: The patients were diagnosed with reverse transcription-polymerase chain reaction test. Demographic, clinical, and laboratory data were collected.
RESULTS: The mean age of population was 38.8 years with male preponderance, of which two patients were residents of Italy, and others hailed from semi-arid and Western sandy arid regions of Rajasthan (urban population). The major presenting symptom complex of said COVID-19 sample population included fever (48%), cough (31%), and shortness of breath (17%). Most of the patients (83%) had no comorbidity. No clinical correlation (r) could be appreciated between the duration of test positivity and age of afflicted COVID-19 patients (r = −0.0976).
CONCLUSIONS: The present evaluation of various facets of the ongoing global pandemic of COVID-19 is an attempt to portray early clinical and epidemiological parameters of the menace of COVID-19 patients admitted at SMS Medical College and Attached Hospitals, Jaipur.
Gingival recession is the term used to characterize the apical shift of the marginal gingiva from its normal position on the crown of the tooth. It is frequently observed in adult subjects. The ...occurrence and severity of the gingival recession present considerable differences between populations. To prevent gingival recession from occurring, it is essential to detect the underlying etiology. The aim of the present study was to determine the occurrence of gingival recession and to identify the most common factor associated with the cause of gingival recession.
A total of 710 subjects aged between 15 years to 60 years were selected. Data were collected by an interview with the help of a proforma and then the dental examination was carried out. The presence of gingival recession was recorded using Miller's classification of gingival recession. The Silness and Loe Plaque Index, Loe and Silness gingival index, community periodontal index were recorded. The data thus obtained were subjected to statistical analysis using Chi-square test and Student's unpaired t-test.
Of 710 subjects examined, 291 (40.98%) subjects exhibited gingival recession. The frequency of gingival recession was found to increase with age. High frequency of gingival recession was seen in males (60.5%) compared to females (39.5%). Gingival recession was commonly seen in mandibular incisors (43.0%). Miller's class I gingival recession was more commonly seen. The most common cause for gingival recession was dental plaque accumulation (44.1%) followed by faulty toothbrushing (42.7%).
Approximately half of the subjects examined exhibited gingival recession. The etiology of gingival recession is multifactorial, and its appearance is always the result of more than one factor acting together.
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