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PubMed2006

Assessment of peripheral DNA damage by alkaline comet assay in maintenance hemodialysis subjects with hepatitis C infection.

Despite the high prevalence of hepatitis C infection among hemodialysis subjects, there is no information concerning the DNA damage of hepatitis C (+) hemodialysis subjects. We aimed to find out if there is any additional effect of hepatitis C infection on peripheral DNA damage in maintenance hemodialysis subjects. Fifteen hepatitis C (+) and 22 hepatitis C (-) hemodialysis subjects, 21 hepatitis C subjects without renal disease, and 22 healthy controls were enrolled. Peripheral DNA damage was assayed using alkaline comet assay. Median DNA damage levels of the study groups were as follows: hepatitis C (+) maintenance hemodialysis subjects, 88 (0-232); hepatitis C (-) maintenance hemodialysis subjects, 58 (0-228); hepatitis C (+) subjects without renal disease, 112 (44-252); controls, 26 (0-72). DNA damage level was significantly higher among hepatitis C (+) subjects without renal disease than hepatitis C (-) maintenance hemodialysis subjects and healthy controls (both p<0.05/6). Both maintenance hemodialysis subjects with and without HCV infection had significantly higher DNA damage level than healthy controls (both p<0.05/6). DNA damage level was comparable between hepatitis C (+) subjects without renal disease and HCV (+) hemodialysis subjects, and between hemodialysis subjects with and without hepatitis C infection (all p>0.05/6). Linear regression analysis revealed that hepatitis C infection was the only independent factor in predicting the peripheral DNA damage (p<0.05, beta=0.395). Each one of end-stage renal disease and hepatitis C infection significantly increases DNA damage level. However, in hemodialysis subjects, hepatitis C infection does not cause significant additional increase in DNA damage level, and it may be partly due to protective effect of hemodialysis on hepatitis C infection.

Adult↗
PubMed2004

Clozapine maintenance therapy in schizophrenia.

Long-term pharmacotherapy with antipsychotic agents is an important aspect of the management of schizophrenia. In patients responsive to the chosen treatment, maintenance therapy is usually conducted by halving the drug dose that has proven effective during the acute phase. This strategy is suitable for maintaining remission; moreover, it can improve the patients' quality of life. Records from over 1000 patients treated with clozapine during the past 22 years were examined; 782 of these patients were diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) criteria (with the modification in early years). From this group, 181 patients were treated with clozapine for at least a year. The mean duration of long-term maintenance treatment with clozapine was 12.2+/-4.25 years (range: from 14.5 months to 18 years). Clozapine was administered in a daily dose of 50-200 mg (mean: 71.5+/-14.12 mg). In 76 schizophrenics, treatment was initiated with clozapine, whereas 105 patients were switched over from other treatments after their failure. The control group comprised 152 patients on long-term maintenance therapy with haloperidol. Clozapine administered for long-term maintenance therapy was effective both in paranoid and in catatonic schizophrenia. It also accomplished good results in patients with disorganized or residual schizophrenia, as well as in individuals with schizoaffective psychosis. Relapse rate was similar to that observed in the haloperidol group; however, patient compliance, side-effect profile, and therapeutic efficacy were all superior in the clozapine group. Long-term maintenance therapy with clozapine is successful. Compliance is good; schizophrenic patients are willing to take this atypical antipsychotic for years on end. Clozapine treatment is associated with a low relapse rate and a favorable safety profile.

Adolescent↗
PubMed2006

Switch and maintenance of task set in schizophrenia.

Task set maintenance and switching deficits are robust in schizophrenia. However, little is known about how these constructs are related to one another. The development of an improved understanding of set switching and maintenance deficits in schizophrenia requires that these constructs be explicated in terms of elementary cognitive processes rather than grouped into broad psychological concepts like executive functioning. A relevant dichotomy has been proposed in which sensory and perceptual ("attentional") processes are distinguished from decisional ("intentional") processes in task maintenance and switching; however, the contributions these processes make to performance deficits in schizophrenia is not known. In the present study, 30 participants with schizophrenia and 27 healthy comparisons completed a cued attentional set switching task. In addition to analyses of mean response times, the contributions of attentional and intentional processes to task performance were estimated using an ex-Gaussian distributional analysis. Schizophrenia was associated with a set maintenance deficit that was accounted for by an attentional, rather than intentional, dysfunction. Both groups showed significant switch costs that could be attributed to attentional processes, but there was no evidence for an attentional set switching deficit in schizophrenia. The findings suggest that set switching and set maintenance may reflect distinct cognitive deficits in schizophrenia and that they may be associated with unique information processing mechanisms.

Adolescent↗
PubMedDate not supplied

Baseline cardiac troponin I in patients on maintenance dialysis.

INTRODUCTION AND OBJECTIVES: There have been conflicting reports in the medical literature regarding baseline levels of cardiac troponins and their usefulness as specific markers of acute myocardial injury in patients on maintenance dialysis. Hence we undertook a study of the normal range of baseline cardiac troponin I (cTnI) in patients on maintenance dialysis in our center. METHODOLOGY: Seventy-five patients aged 45 years or more on maintenance dialysis for at least 1 month were included in the study. None had had an acute cardiac event requiring admission to the hospital during the preceding month. Samples of blood were collected and cTnI levels were estimated using an immunoenzymatic assay (Access Immunoassay system, Beckmann). Correlation of cTnI with gender, age, body mass index (BMI), and adequacy of dialysis (Kt/v) were also done. RESULTS: Forty-six (61.3%) patients were on maintenance hemodialysis and 29 (38.6%) were on peritoneal dialysis. Twenty-four (32%) were over the age of 65 years and 37 (49.3%) were men. Levels of cTnI ranged from 0.000 to 0.568 ng/mL, with mean of 0.040 +/- 0.080. Only six (8%) had levels above 0.1 ng/mL, which was the cut off level for significance in our laboratory. There was no statistically significant correlation of cTnI levels with gender, age, BMI, or Kt/v. CONCLUSIONS: Baseline cTnI levels were below significant levels in the majority of maintenance dialysis patients aged at least 45 years or more. Hence cTnI can be used as a valid marker of acute myocardial injury in this group of patients.

Aged↗
PubMed1997

Body dysmorphic disorder: a preliminary evaluation of treatment and maintenance using exposure with response prevention.

In recent investigations, body dysmorphic disorder (BDD) has been shown to share common etiological and symptom presentation to obsessive-compulsive disorder (OCD). When treating BDD, there have been some investigations suggesting that exposure with response prevention is effective in alleviating symptoms. Ten patients diagnosed with BDD participated in a study examining the effects of treatment and maintenance using exposure with response prevention. They received a standard behavior therapy protocol which consisted of exposure in vivo and in imagery, with response prevention. Symptom severity, depression, anxiety, and avoidance were assessed weekly during treatment. Following treatment, a 6-month maintenance program was instituted for five patients, with the other five serving as controls. Patients in the maintenance program were assessed bi-weekly with all measures and a 6-month follow-up was conducted. Patients improved for measures of avoidance, BDD symptoms, depression and anxiety when using exposure with response prevention. Although all patients remained symptom free at follow-up, those in the maintenance program continued to improve. Based on these results, BDD appears to be amenable to exposure with response prevention treatment. Additional treatment gains can be obtained when structured maintenance programs are implemented.

Adult↗
PubMed2003

Randomized, placebo-controlled trial of nefazodone maintenance treatment in preventing recurrence in chronic depression.

BACKGROUND: Maintenance treatment to prevent recurrences is recommended for chronic forms of major depressive disorder (MDD), but few studies have examined maintenance efficacy of antidepressants with chronic MDD. This randomized, placebo-controlled study of the efficacy and safety of nefazodone in preventing recurrence was conducted for patients with chronic MDD. METHODS: A total of 165 outpatients with chronic, nonpsychotic MDD, MDD plus dysthymic disorder ("double-depression"), or recurrent MDD with incomplete inter-episode recovery, who achieved and maintained a clinical response during acute and continuation treatment with either nefazodone alone or nefazodone combined with psychotherapy, were randomized to 52 weeks of double-blind nefazodone (maximum dose 600 mg/day) or placebo. The occurrence of major depressive episodes during maintenance treatment was assessed with the 24-item Hamilton Rating Scale for Depression, a DSM-IV MDD checklist, and a blinded review of symptom exacerbations by a consensus committee of research clinicians. RESULTS: Application of a competing-risk model that estimated the conditional probability of recurrence among those patients remaining on active therapy revealed a significant (p =.043) difference between nefazodone (n = 76) and placebo (n = 74) when the latter part of the 1-year maintenance period was emphasized. At the end of 1 year, the conditional probability of recurrence was 30.3% for nefazodone-treated patients, compared with 47.5% for placebo-treated patients. Prior concomitant psychotherapy during acute/continuation treatment, although enhancing the initial response, was not associated with lower recurrence rates. Discontinuations due to adverse events were relatively low for both nefazodone (5.3%) and placebo (4.8%). Somnolence was significantly greater among the patients taking active medication (15.4%), compared with placebo (4.6%). CONCLUSIONS: Nefazodone is well-tolerated and is an effective maintenance therapy for chronic forms of MDD.

Acute Disease↗
PubMed2002

Monitoring of arsenic exposure with speciated urinary inorganic arsenic metabolites for ion implanter maintenance engineers.

For wafer fabrication in the semiconductor industry, maintenance engineers are potentially exposed to hazards during their work of disassembling machine components for cleanup. One special concern is the presence of arsenic or arsenic compounds in the working environment. This study analyzed speciated urinary inorganic arsenic metabolites of the maintenance engineers using high-performance liquid chromatography-hydride generation atomic absorption spectrometry to study the potential arsenic exposure during their maintenance work. In total, from six wafer fabrication facilities, 30 maintenance engineers were recruited as the exposed group and another 12 office-based engineers served as the control group. First morning-voided urine samples of each study subject were collected for 7 consecutive days. The levels of total urinary inorganic arsenic metabolites for the exposed group were 1.7+/-1.4, 1.4+/-1.1, 6.2+/-6.7, 20.2+/-14.1, and 29.5+/-17.2 micro g/L for As3+, As5+, monomethylarsonic acid, dimethylarsinic acid, and total inorganic arsenic, respectively. Both the concentration of monomethylarsonic acid and its percentage in total urinary inorganic arsenic metabolites showed significantly ascending trends for the control group, for the engineers without preventative maintenance work prior to their urine sampling, and for the engineers with such work prior to their urine sampling (P<0.05 and P<0.0005, respectively). The data also suggested that, at low-level occupational arsenic exposure, the concentration of total urinary inorganic arsenic metabolites might be misleading due to the confounding effect resulting from intake of seafood, such as arsenosuger. Nevertheless, monitoring of urinary arsenic species by using the percentage change of monomethylarsonic acid in total urinary inorganic arsenic metabolites as an indicator for the verification of arsenic exposure is helpful and appropriate in such cases.

Adult↗
PubMed1982

The hormonal maintenance and restoration of guinea pig seminal vesicle fibromuscular stroma.

Using the separated epithelium and muscle preparation of the guinea pig seminal vesicle, we designed studies to investigate the hormonal control of epithelial collagen, muscle collagen and muscle cells. All hormone treatment regimens involved a comparison of the effects of hormone maintenance (homrone treatments initiated on the day of castration) versus hormone restoration (hormone treatments initiated after a castration-induced regression) on these 3 components of the fibromuscular stroma. In the epithelium, castration induced a 35 per cent decline in collagen content, which was either returned to normal by androgen restoration of prevented by androgen maintenance. In all androgen treatment regimens, changes in epithelial collagen correlated with changes in epithelial wet weight, cell number, RNA content and cell size. In contrast, growth of the epithelium was not stimulated by estrogen maintenance or restoration. Castration reduced muscle wet and dry weight, as well as cell size and RNA content, but there was no effect on cell number and collagen content. Androgen maintenance or restoration reversed the castration-induced regression in all parameters and also caused collagen content to increase 35 percent above normal. Estrogen maintenance of castrates sustained wet weight, dry weight and RNA content at normal and stimulated supranormal increases in both collagen content and cell number. Similarly, estrogen restoration induced supranormal increases in collagen content and returned RNA content to normal. However, estrogen's ability to stimulate supranormal increases in cell number and restore wet and dry weight to normal was lost after a castration-induced muscle regression. In summary, components of the guinea pig seminal vesicle fibromuscular stroma have been shown to be sensitive to androgens and/or estrogens. The action of androgen on these tissue components was independent of the state of tissue regression, whereas with the exception of RNA and collagen content all the effects of estrogen were significantly reduced with castration-induced regression of the tissue.

Animals↗
PubMed2003

Functional topography of a distributed neural system for spatial and nonspatial information maintenance in working memory.

We investigated the degree to which the distributed and overlapping patterns of activity for working memory (WM) maintenance of objects and spatial locations are functionally dissociable. Previous studies of the neural system responsible for maintenance of different types of information in WM have reported seemingly contradictory results concerning the degree to which spatial and nonspatial information maintenance leads to distinct patterns of activation in prefrontal cortex. These inconsistent results may be partly attributable to the fact that different types of objects were used for the "object WM task" across studies. In the current study, we directly compared the patterns of response during WM tasks for face identity, house identity, and spatial location using functional magnetic resonance imaging (fMRI). Furthermore, independence of the neural resources available for spatial and object WM was tested behaviorally using a dual-task paradigm. Together, these results suggest that the mechanisms for the maintenance of house identity information are distributed and overlapping with those that maintain spatial location information, while the mechanisms for maintenance of face identity information are relatively more independent. There is, however, a consistent functional topography that results in superior prefrontal cortex producing the greatest response during spatial WM tasks, and middle and inferior prefrontal cortices producing their greatest responses during object WM tasks, independent of the object type. These results argue for a dorsal-ventral functional organization for spatial and nonspatial information. However, objects may contain both spatial and nonspatial information and, thus, have a distributed but not equipotent representation across both dorsal and ventral prefrontal cortex.

Adolescent↗
PubMed2003

The spacing between adjacent binding sites in the family of repeats affects the functions of Epstein-Barr nuclear antigen 1 in transcription activation and stable plasmid maintenance.

Epstein-Barr virus (EBV) and the closely related Herpesvirus papio (HVP) are stably replicated as episomes in proliferating latently infected cells. Maintenance and partitioning of these viral plasmids requires a viral sequence in cis, termed the family of repeats (FR), that is bound by a viral protein, Epstein-Barr nuclear antigen 1 (EBNA1). Upon binding FR, EBNA1 maintains viral genomes in proliferating cells and activates transcription from viral promoters required for immortalization. FR from either virus encodes multiple binding sites for the viral maintenance protein, EBNA1, with the FR from the prototypic B95-8 strain of EBV containing 20 binding sites, and FR from HVP containing 8 binding sites. In addition to differences in the number of EBNA1-binding sites, adjacent binding sites in the EBV FR are typically separated by 14 base pairs (bp), but are separated by 10 bp in HVP. We tested whether the number of binding sites, as well as the distance between adjacent binding sites, affects the function of EBNA1 in transcription activation or plasmid maintenance. Our results indicate that EBNA1 activates transcription more efficiently when adjacent binding sites are separated by 10 bp, the spacing observed in HVP. In contrast, using two separate assays, we demonstrate that plasmid maintenance is greatly augmented when adjacent EBNA1-binding sites are separated by 14 bp, and therefore, presumably lie on the same face of the DNA double helix. These results provide indication that the functions of EBNA1 in transcription activation and plasmid maintenance are separable.

Binding Sites↗
PubMed2000

Roles of pulsatile release of LH in the development and maintenance of corpus luteum function in the goat.

The roles of the pulsatile release of LH in the functional development and maintenance of the corpus luteum (CL) during the estrus cycle in the goat were examined using a potent GnRH antagonist. In Experiment 1, to assess the inhibitory effects of the GnRH antagonist on the release of LH during the estrus cycle, 9 goats were divided into 3 groups. Goats in Group I received only saline on Days 0 (day of ovulation), 5, 10 and 15. Goats in Group II received the GnRH antagonist (50 microg/kg, s.c.) on the days mentioned for Group I to inhibit endogenous LH during the periods of luteal development and maintenance. Goats in Group III received saline on Days 0 and 5 and then the GnRH antagonist on Days 10 and 15 to inhibit LH during the period of luteal maintenance. Serial blood sampling took place on Days 1, 3, 5, 8, 13 and 18 to characterize the LH pulses. The LH pulses were observed throughout the estrus cycle in Group I but were completely abolished in Group II. In Group III, the pulsatile release of LH was observed from Day 1 to 8, but the LH pulses were completely abolished on Days 13 and 18. In Experiment 2, 16 goats were divided into the same 3 groups as in Experiment 1 to examine the effects of the GnRH antagonist on the luteal function. The concentration of progesterone in the plasma in Group I increased after ovulation, reached a maximum level around Day 12, and subsequently returned to the basal level on Day 17. The concentrations of progesterone in Group II rose after ovulation, but reached a plateau around Day 6 and maintained the level up to Day 9, then rapidly decreased from Day 9 to 10 to the basal level. The concentrations of progesterone in Group II were lower on Days 7 to 15 than those in Group I (P<0.01). The concentrations of progesterone in Group III increased after ovulation, reached a maximum level around Day 8, then dropped from Day 10 to 13 to the basal level. The concentrations of progesterone in Group III on Days 11 to 15 were lower than those in Group I (P<0.05 on Day 11, P<0.01 on Days 12 to 15). These results demonstrate that endogenous LH is essential for normal development and maintenance of the CL function during the estrus cycle in the goat. Further, this study suggests that while the functional maintenance of the caprine CL depends entirely on LH support, such functional dependence during early CL development is only partial.

Animals↗
PubMed2006

Rituximab maintenance therapy in indolent NHL: a clinical review.

Rituximab maintenance therapy following successful induction has emerged as a highly effective treatment for follicular lymphoma. Several randomized trials have been conducted analyzing the impact of rituximab maintenance compared to observation alone on treatment outcome. These studies have been conducted in patients receiving single-agent rituximab, standard chemotherapy or rituximab plus chemotherapy as initial cytoreduction, in both previously treated and untreated patients. In all the trials, rituximab maintenance resulted in a clinically and statistically significant benefit in clinical endpoints such as progression-free survival. Moreover, first data indicate that rituximab maintenance can prolong overall survival in patients with follicular lymphoma. These data have established rituximab maintanance as an important part of multimodal therapeutic strategies. Ongoing studies will help to determine the best schedule for the maintenance therapy in the treatment of follicular lymphoma.

Antibodies, Monoclonal↗
PubMed1998

Sequential variceal pressure measurement by endoscopic needle puncture during maintenance sclerotherapy: the correlation between variceal pressure and variceal rebleeding.

BACKGROUND/AIMS: The risk factors for esophageal variceal rebleeding are little known. Variceal pressure is one of the major determinants of variceal rupture, but the relationship between variceal pressure and variceal rebleeding during maintenance sclerotherapy has not been determined. This study was undertaken to evaluate the relationship between variceal pressure/gradient change and variceal rebleeding during maintenance sclerotherapy. METHODS: Patients with liver cirrhosis and recent esophageal variceal hemorrhage underwent consecutive variceal pressure measurements by direct puncture of the varices before each elective sclerotherapy. RESULTS: In 46 patients, the initial variceal pressure was no different regardless of age, sex, underlying etiology or hepatic reserve. Variceal pressure was higher in large varices, varices with more severe red wale markings, and varices with slower reduction in size during maintenance sclerotherapy. A larger volume of sclerosant was required to eradicate large varices, varices with more severe red wale markings, and varices with slower reduction in size during maintenance sclerotherapy. There was a positive correlation between initial variceal pressure and total amount of sclerosant (r=0.485, p=0.001). Initial variceal pressure was not related to rebleeding. Variceal pressure increased more in patients with rebleeding from varices per se (n=7) than in those without rebleeding (n= 24). There was no difference in pressure change between patients without rebleeding (n=24) and those with rebleeding from variceal ulcers (n=7). CONCLUSIONS: Large varices, severe red color signs and slow reduction in variceal size were associated with higher initial variceal pressure, and more sclerosant was required to eradicate the varices. An increase in variceal pressure during maintenance sclerotherapy indicates a higher risk of variceal rebleeding, but not of variceal ulcer rebleeding.

Aged↗
PubMed2003

Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy.

BACKGROUND: Hypoalbuminemia is a powerful predictor of cardiovascular mortality in maintenance hemodialysis patients. Increased biomarkers of acute-phase inflammation and oxidative stress are highly prevalent and also correlate with cardiovascular morbidity and mortality. The extent to which hypoalbuminemia, biomarkers of inflammation, and biomarkers of oxidative stress are linked in this patient population is unknown. We hypothesized that a high proportion of hypoalbuminemic hemodialysis patients also would manifest increased levels of biomarkers of inflammation and oxidative stress. METHODS: We surveyed 600 maintenance hemodialysis patients and identified 18 severely hypoalbuminemic patients (serum albumin level < 3.2 g/dL [32 g/L]) without recent infection or hospitalization. We then identified 18 age-, race-, sex-, and diabetes-matched normoalbuminemic hemodialysis patients, as well as 18 age-, race-, sex-, and diabetes-matched healthy subjects, for cohort comparison. Measurements of plasma interleukin-6 (IL-6) levels, plasma protein reduced thiol content, plasma protein carbonyl content, and plasma free F2-isoprostane levels, as well as serum concentrations of C-reactive protein (CRP) and prealbumin, were performed for study purposes. RESULTS: Levels of serum CRP, IL-6, plasma protein thiol oxidation, and protein carbonyl formation were significantly elevated in both hypoalbuminemic and normoalbuminemic hemodialysis patients compared with healthy subjects and also were significantly different in hypoalbuminemic maintenance dialysis patients compared with normoalbuminemic hemodialysis patients. Prealbumin levels were significantly lower in hypoalbuminemic hemodialysis patients than in other groups. CONCLUSION: There is a high prevalence of inflammation and oxidative stress in the maintenance hemodialysis population. Levels of inflammatory and oxidative stress biomarkers are increased further in hypoalbuminemic compared with normoalbuminemic dialysis patients. Hypoalbuminemia, acute-phase inflammation, and oxidative stress may act synergistically to increase cardiovascular morbidity and mortality risk in maintenance hemodialysis patients.

Aged↗
PubMed1994

Effect of nutrition on morbidity and mortality in maintenance dialysis patients.

Protein-calorie malnutrition is common in maintenance dialysis patients. Malnutrition is mild to moderate in approximately 33% of maintenance dialysis patients and severe in approximately 6% to 8%. There are many causes of protein-calorie malnutrition in maintenance dialysis patients; the three major causes are probably low nutrient intakes, intercurrent or underlying illnesses, and the dialysis procedure itself. Malnutrition is a major risk factor for mortality in maintenance dialysis patients. This has been shown most clearly for serum albumin, which is the nutritional parameter that has been most heavily studied. Low dietary of protein or other nutrients and protein-calorie malnutrition revealed by the results of different chemistry analyses are also directly correlated with mortality rates. These data do not prove that poor nutritional intake or malnutrition is a cause of the high morbidity and mortality in maintenance dialysis patients, and randomized, prospective controlled clinical trials are necessary to answer this question. However, the data are consistent with the thesis that malnutrition or inadequate nutrient intake do contribute to high morbidity and mortality in these patients. Although it is possible that increasing the dose of dialysis (eg, Kt/V) will lead to increased appetite and nutrient intake, experience suggests that raising the dose of dialysis, by itself, will not optimize nutritional intake in these individuals. To achieve satisfactory nutritional intake and healthy nutritional status, other interventions will need to be developed.

Blood Urea Nitrogen↗
PubMed2003

Comparative pharmacodynamics and pharmacokinetics of methadone and slow-release oral morphine for maintenance treatment of opioid dependence.

BACKGROUND: Slow-release oral morphine (SROM) has been proposed as an alternative maintenance pharmacotherapy to methadone for treatment of opioid dependence. However, the pharmacodynamics and pharmacokinetics of SROM have not been previously assessed in a methadone maintenance population. METHODS: In 14 methadone maintenance patients reporting adequate (holders, n=7) or inadequate (non-holders, n=7) withdrawal suppression between doses, plasma drug concentrations and indices of opioid effect (withdrawal severity, pupil diameter, and respiratory rate) were determined across a 24 h inter-dosing interval on one occasion at steady-state for methadone and SROM (once-daily Kapanol) using an open-label, crossover design. RESULTS: Opioid effects were of a similar overall magnitude following dosing for each drug and showed an inverse association with plasma drug concentrations, which peaked later for morphine compared to (R)-methadone (6.5 +/- 2.3 h vs. 2.5 +/- 1.4 h, P<0.001). For methadone non-holders, the number of self-reported opioid withdrawal symptoms prior to dosing was less for SROM compared to methadone (3.4 +/- 2.6 vs. 9.0 +/- 3.2, P<0.01); for holders it was approximately equal (4.4 +/- 3.0 vs. 4.0 +/- 3.7, P<0.76). Maintenance doses were more strongly related to plasma drug concentrations for SROM compared to methadone and may thus be more predictive of therapeutic response for the former medication. Twelve of the 14 subjects preferred SROM to methadone (P=0.01). CONCLUSIONS: The pharmacodynamics and pharmacokinetics of SROM support its use as an alternative once-daily agonist option in the treatment of opioid dependence, particularly for patients responding poorly to methadone maintenance treatment.

Administration, Oral↗
PubMed2002

A novel opioid maintenance program for prisoners: preliminary findings.

Effective postincarceration treatment for individuals with preincarceration heroin dependence is urgently needed because relapse typically follows release. This article presents first-year findings from a unique 2-year pilot study of opioid agonist maintenance treatment initiated in prison and continued in the community. Incarcerated males with preincarceration heroin dependence were randomly assigned to Levo-alpha-acetylmethadol (LAAM) maintenance or control conditions 3 months before release. Approximately 92% of eligible inmates volunteered to participate; 36 of 58 subjects who were eligible and randomly assigned to LAAM maintenance successfully initiated treatment. Twenty-eight of these continued on LAAM until release; 22 (78.6%) entered community-based maintenance treatment; and 11 (50%) remained in treatment at least 6 months postrelease. Changes in LAAM's labeling because of its association with cardiac arrhythmias now makes it a second-line treatment for heroin dependence, unsuitable for treatment initiation. Nonetheless, study findings may also be applicable to methadone maintenance treatment, suggesting such treatment may be a promising means of engaging prisoners with preincarceration heroin dependence into continuing treatment.

Adult↗
PubMed2001

Medial temporal lobe activity associated with active maintenance of novel information.

Using event-related functional magnetic resonance imaging, we investigated the role of medial temporal regions during active maintenance of information over short delays or working memory. In experiment 1, we observed sustained bilateral hippocampal activation during maintenance of novel faces across a short delay period but not during face encoding or recognition. In contrast, we observed transient right parahippocampal activation during encoding and recognition but not during maintenance. We replicated these findings in experiment 2 and further determined that anterior hippocampal activation was greater during maintenance of novel than familiar faces. Our results reveal the importance of medial temporal lobe regions for the active maintenance of novel information in the absence of perceptual stimulation.

Brain Mapping↗