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PubMed1998

Maintenance treatment of opiate addicts in Germany with medications containing codeine--results of a follow-up study.

AIMS: Outpatient maintenance treatment of opiate addicts with codeine/dihydrocodeine is a common approach in the treatment of drug addicts in Germany. This study was carried out to assess possible benefits of codeine maintenance in terms of patients' health stabilization, social rehabilitation and drug consumption. DESIGN: Three-year follow-up study. SETTING: Three practices of substituting physicians in large-city areas in Germany. PARTICIPANTS: Of a random sample of 297 people attending for opiate outpatient treatment in 1993, 199 were successfully followed up 3 years later. MEASUREMENTS: Measures of health, living conditions, employment, criminal activities and drug use were collected at baseline and follow-up. The data were based on standardized interviews and medical examinations by the attending doctors as well as on questionnaires from the patients. FINDINGS: Based on a 67%-follow-up rate, after 3 years of codeine maintenance there was improvement in general health and mental problems. The living and working situation remained more or less unchanged and stabilized at a satisfactory level. The same applies to the consumption of drugs. CONCLUSION: The patients' progress shown in this study was comparable to that achieved by methadone maintenance in similar geographical regions. Codeine has a weaker pharmacological effects and our results suggest that codeine maintenance treatment deserves more attention and controlled trials to assess the benefits compared with methadone (or other opioids).

Adult↗
PubMed1997

Maintenance therapy with cisapride after healing of erosive oesophagitis: a double-blind placebo-controlled trial.

BACKGROUND: There are few data on the role of prokinetic agents as maintenance therapy in moderately severe reflux oesophagitis despite the high relapse rate of this condition after healing. AIMS: To determine whether cisapride is more effective than placebo as maintenance therapy after healing of moderate erosive oesophagitis in two respects: first, in preventing symptomatic relapse and preserving quality of life; and, second, in improving oesophageal motor function. PATIENTS: Forty-two patients whose grade II-III oesophagitis had been healed with omeprazole were randomized to receive either cisapride 20 mg nocte or placebo for 6 months. Oesophageal pH monitoring and manometry were performed before starting maintenance therapy and after 4 weeks, and symptomatic status and quality of life were assessed at weeks 0, 4, 13 and 26. RESULTS: After 4 weeks of maintenance therapy, lower oesophageal sphincter pressure improved in the cisapride group (16.4-21.9 mmHg, P = 0.01) but not in the placebo group (25.5-22.7 mmHg, P = 0.2). Oesophageal pH monitoring showed no significant changes in either group. Sixteen (76%) cisapride patients and 12 (57%) placebo patients withdrew within 4 weeks owing to symptomatic relapse (P = 0.2). After 26 weeks, 21 (100%) cisapride and 17 (81%) placebo patients had relapsed (log-rank analysis of survival time P = 0.07). Quality of life parameters deteriorated in both treatment groups to a similar degree. CONCLUSION: Maintenance therapy with cisapride 20 mg nocte improves the lower oesophageal sphincter pressure in patients whose oesophagitis has been healed with omeprazole. However, cisapride is no better than placebo in preventing symptomatic relapse or deterioration in quality of life.

Adult↗
PubMed1999

Helicobacter pylori treatment instead of maintenance therapy for peptic ulcer disease: the effectiveness of case-finding in general practice.

BACKGROUND: Maintenance therapy with acid-inhibiting medication is common in general practice. Since the eradication of Helicobacter pylori has become the treatment of choice for peptic ulcer disease, H. pylori treatment could replace maintenance therapy in patients with an ulcer history. AIM: To determine the effectiveness of a full peptic ulcer disease history case-finding strategy, together with subsequent H. pylori testing and treatment, in discontinuing maintenance therapy. METHOD: Patients were included from seven general practices, who had been using acid-inhibiting medication for more than 3 months in the period May 1996-May 1997. Patients with a history of proven peptic ulcer disease were tested, and treated with proton pump inhibitor-triple therapy if positive. Maintenance therapy was discontinued and restart within 12 months was monitored. RESULTS: Long-term acid suppression was used by 2.8% of the practice-populations. A peptic ulcer disease history was found in 18% of the patients, 73% of whom were offered the 'H. pylori test and treat' alternative. The majority responded: 92% of the H. pylori-infected patients were treated, 78% of whom successfully discontinued long-term medication. CONCLUSION: Implementing an 'H. pylori test and treat' strategy enabled one-third of the patients with a peptic ulcer disease history to stop maintenance therapy successfully. The strategy contributes to reduction of long-term drug use, but compliance needs improvement.

Antacids↗
PubMed1999

Prediction of the international normalized ratio and maintenance dose during the initiation of warfarin therapy.

AIMS: A pharmacokinetic/pharmacodynamic model, with Bayesian parameter estimation, was used to retrospectively predict the daily International Normalized Ratios (INRs) and the maintenance doses during the initiation of warfarin therapy in 74 inpatients. METHODS: INRs and maintenance doses predicted by the model were compared with the actual INRs and the eventual maintenance dose. Cases with drugs or medical conditions interacting with warfarin or receiving concurrent heparin therapy were not excluded. As the study was retrospective, model predictions of the maintenance dose were not those that were administered. Mean prediction error (MPE) and percentage absolute prediction errors (PAPE) were used to assess the model predictions. RESULTS: INR MPE ranged from -0.07 to 0.06 and median PAPE from 10% to 20%. Dose MPE ranged from -0.7 to 0.17 mg and median PAPE from 16.7% to 37.5%. Accurate and precise dose predictions were obtained after 3 or more INR feedback's. CONCLUSIONS: This study shows that the model can accurately predict daily INRs and the maintenance dose in this sample of cases. The model can be incorporated into computer decision-support systems for warfarin therapy and may lead to improvement in the initiation of warfarin therapy.

Adult↗
PubMed2003

Trace elements and vitamins in maintenance dialysis patients.

Although protein-energy malnutrition occurs commonly in patients with end-stage renal disease undergoing maintenance dialysis treatment, it is not the only form of malnutrition that may exist in these individuals. They may also suffer from deficiencies of micronutrients, particularly trace elements and vitamins. More commonly occurring vitamin deficiencies in maintenance dialysis patients include those for vitamin C (ascorbate), folate, vitamin B6 (pyridoxine), and 1,25-dihydroxycholecalciferol (calcitriol). Among trace elements, deficiencies may occur more commonly for iron, zinc, and possibly selenium, whereas toxicities are more common with aluminum and possibly copper. Evidence suggests that there is an abnormally high prevalence of antioxidant deficiency in maintenance dialysis patients, especially because a low intake of protein and energy may be associated with inadequate ingestion of antioxidant vitamins (ie, vitamins E and C and carotenoids). Thus, some micronutrient deficiencies in maintenance dialysis patients may contribute to the development of atherosclerotic cardiovascular disease. Dietary requirements for vitamins and trace elements in maintenance dialysis patients are reviewed and the recommended daily intakes are discussed.

Avitaminosis↗
PubMed2005

Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn's disease.

BACKGROUND & AIMS: Infliximab is effective in closing fistulas in patients with Crohn's disease. We examined the effect of infliximab maintenance treatment on hospitalizations, surgeries, and procedures in patients with fistulizing Crohn's disease enrolled in the ACCENT II study. METHODS: After 5 mg/kg infliximab at weeks 0, 2, and 6, a total of 282 patients were separately randomized at week 14 as responders (at least a 50% reduction from baseline in the number of draining fistulas at both weeks 10 and 14) or nonresponders to receive placebo or 5 mg/kg infliximab maintenance every 8 weeks. At week 22 and later, patients who lost response could be treated with a maintenance dose 5 mg/kg higher. Data on Crohn's disease-related hospitalizations, surgeries, and procedures were compared between the treatment groups for responders and all randomized patients. RESULTS: A total of 282 patients were randomized at week 14, of whom 195 were randomized as responders. Among patients randomized as responders, those who received infliximab maintenance had significantly fewer mean hospitalization days (0.5 vs. 2.5 days; P < .05), mean numbers (per 100 patients) of hospitalizations (11 vs. 31; P < .05), all surgeries and procedures (65 vs. 126; P < .05), inpatient surgeries and procedures (7 vs. 41; P < .01), and major surgeries (2 vs. 11; P < .05), compared with those who received placebo maintenance. CONCLUSIONS: In patients with fistulizing Crohn's disease, infliximab 5 mg/kg every 8 weeks significantly reduced hospitalizations, surgeries, and procedures compared with placebo.

Adult↗
PubMed1981

The role of maintenance therapy in disseminated testicular cancer.

We concluded a prospective study of the value of maintenance therapy in disseminated testicular cancer after chemotherapy-induced complete remission or chemotherapy cytoreduction followed by surgical resection of residual teratoma. A group of 171 patients were randomized to treatment consisting of cisplatin, vinblastine, and bleomycin, or these drugs plus doxorubicin. There was no apparent difference between these two induction regimens. Complete remission was achieved in 113 patients (66 per cent), and 19 (11 per cent) were free of disease by surgical resection of residual tumor. Of the 171 who started, 113 were eligible to receive either maintenance doses of vinblastine (58 patients) or no further therapy (55 patients) after remission-induction therapy. There was a 9 per cent relapse rate during maintenance with vinblastine and a 7 per cent relapse rate with no maintenance therapy; the overall relapse rate was 8 per cent (nine of 113). Our data indicate that maintenance therapy is unnecessary in disseminated testicular cancer.

Adolescent↗
PubMed1995

Transdermal nicotine as maintenance therapy for ulcerative colitis.

BACKGROUND: Ulcerative colitis is largely a disease of nonsmokers. Having found previously that treatment with transdermal nicotine patches and mesalamine (5-aminosalicylic acid) has a beneficial effect on active colitis, we examined the value of transdermal nicotine for the maintenance of remission. METHODS: We treated 80 patients with ulcerative colitis in remission with either transdermal nicotine or placebo patches for six months in a randomized, double-blind study. Incremental doses of nicotine were given for the first three weeks to achieve a maintenance dose; most patients tolerated 15 mg for 16 hours daily. All patients were taking mesalamine preparations as maintenance treatment at entry into the study; this treatment was stopped once the maintenance dose of nicotine was achieved. Clinical, sigmoidoscopic, and histologic assessments were made at the beginning and the end of the study, or at relapse. Side effects and serum nicotine and cotinine concentrations were monitored throughout the study. RESULTS: There was no significant difference in the number of relapses between the groups. Twenty-two patients in the nicotine group were prematurely withdrawn from the study, 14 because of relapse and 8 for other reasons, including side effects and protocol violations. In the placebo group, 20 patients were withdrawn prematurely, 17 because of relapse and 3 for other reasons. Among patients using 15-mg nicotine patches, serum nicotine and cotinine concentrations were lower than expected and may reflect poor compliance. Side effects were reported by 35 patients--21 in the nicotine group and 14 in the placebo group--the most common of which were nausea, lightheadedness, and itching. CONCLUSIONS: Transdermal nicotine alone was no better than placebo in the maintenance of remission of ulcerative colitis, and premature withdrawal due to side effects was more common in the nicotine group.

Administration, Cutaneous↗
PubMed1998

Maintenance antiretroviral therapies in HIV-infected subjects with undetectable plasma HIV RNA after triple-drug therapy. AIDS Clinical Trials Group Study 343 Team.

BACKGROUND: Combination antiretroviral therapy with indinavir, zidovudine, and lamivudine can suppress the level of human immunodeficiency virus (HIV) RNA in plasma below the threshold of detection for two years or more. We investigated whether a less intensive maintenance regimen could sustain viral suppression after an initial response to combination therapy. METHODS: HIV-infected subjects who had CD4 cell counts greater than 200 per cubic millimeter, who had been treated with indinavir, lamivudine, and zidovudine, and who had less than 200 copies of HIV RNA per milliliter of plasma after 16, 20, and 24 weeks of induction therapy were randomly assigned to receive either continued triple-drug therapy (106 subjects), indinavir alone (103 subjects), or a combination of zidovudine and lamivudine (107 subjects). The primary end point was loss of viral suppression, which was defined as a plasma level of at least 200 copies of HIV RNA per milliliter on two consecutive measurements during maintenance therapy. RESULTS: During maintenance treatment, 23 percent of the subjects receiving indinavir and 23 percent of those receiving zidovudine and lamivudine, but only 4 percent of those receiving all three drugs, had loss of viral suppression (P<0.001 for the comparison between triple-drug therapy and the other two maintenance regimens). Subjects with greater increases in CD4 cell counts during induction therapy, higher viral loads at base line (i.e., at the beginning of induction therapy), and slower rates of viral clearance were at greater risk for loss of viral suppression. The presence of zidovudine-resistance mutations in HIV RNA at base line was strongly predictive of the loss of viral suppression in subjects treated with zidovudine and lamivudine. CONCLUSIONS: The suppression of plasma HIV RNA after six months of treatment with indinavir, zidovudine, and lamivudine is better sustained by the continuation of these three drugs than by maintenance therapy with either indinavir alone or zidovudine and lamivudine.

Adult↗
PubMed2004

Distinct dosage requirements for the maintenance of long and short telomeres in mTert heterozygous mice.

Telomerase is a ribonucleoprotein containing an essential telomerase RNA template and telomerase reverse transcriptase (TERT) that maintains telomeres. The dosage requirements for mammalian TERT in telomere length homeostasis are not known, but are of importance in cellular senescence, stem cell renewal, and cancer. Here, we characterize telomere maintenance and function upon successive breeding of mice deficient in mTert. These studies reveal a unique dosage requirement for telomere length maintenance by TERT; despite haploinsufficiency for the maintenance of long telomeres, mTert+/- mice retain minimal telomere DNA at all chromosome ends and do not exhibit the infertility typical of telomerase-deficient strains. Unlike the long (>50 kbp) average telomere lengths of wild-type laboratory mice, mTert+/- animals mice possess short telomere lengths similar to humans and wild-derived mice. Unexpectedly, mTert+/- mice are ersatz carriers for genetic instability, because their mating led to accelerated genetic instability and infertility in null progeny. Thus, limiting TERT levels play a key role in the maintenance of genome integrity, with important ramifications for the maintenance of short telomeres in human cancer and aging.

Alleles↗
PubMed1993

Mechanism of protein kinase C activation during the induction and maintenance of long-term potentiation probed using a selective peptide substrate.

Previous reports using various protein kinase inhibitors have suggested that protein kinase activity is necessary for both the induction and maintenance of hippocampal long-term potentiation (LTP), a cellular phenomenon likely to contribute to mammalian memory formation. We designed and characterized a selective peptide substrate for protein kinase C (PKC), corresponding to amino acids 28 to 43 of the neuronal protein neurogranin, and used the substrate to obtain direct biochemical evidence for activation of PKC in both the induction and maintenance phases of LTP. As the effect cannot be accounted for by either of two well-known mechanisms for persistent PKC activation, membrane insertion, or proteolysis, the persistent activation of PKC in the maintenance phase of LTP appears to occur via another mechanism. The maintenance phase of LTP is associated with decreased immunoreactivity of PKC, an effect that can be reversed with phosphatase treatment. Thus, PKC appears to be both phosphorylated and persistently activated in the maintenance phase of LTP.

Animals↗
PubMed1993

Persistent activation of the zeta isoform of protein kinase C in the maintenance of long-term potentiation.

Long-term potentiation in the CA1 region of the hippocampus, a model for memory formation in the brain, is divided into two phases. A transient process (induction) is initiated, which then generates a persistent mechanism (maintenance) for enhancing synaptic strength. Protein kinase C (PKC), a gene family of multiple isozymes, may play a role in both induction and maintenance. In region CA1 from rat hippocampal slices, most of the isozymes of PKC translocated to the particulate fraction 15 sec after a tetanus. The increase of PKC in the particulate fraction did not persist into the maintenance phase of long-term potentiation. In contrast, a constitutively active kinase, PKM, a form specific to a single isozyme (zeta), increased in the cytosol during the maintenance phase. The transition from translocation of PKC to formation of PKM may help to explain the molecular mechanisms of induction and maintenance of long-term potentiation.

Amino Acid Sequence↗
PubMed2001

Telomerase can inhibit the recombination-based pathway of telomere maintenance in human cells.

Telomere length can be maintained by telomerase or by a recombination-based pathway. Because individual telomeres in cells using the recombination-based pathway of telomere maintenance appear to periodically become extremely short, cells using this pathway to maintain telomeres may be faced with a continuous state of crisis. We expressed telomerase in a human cell line that uses the recombination-based pathway of telomere maintenance to test whether telomerase would prevent telomeres from becoming critically short and examine the effects that this might have on the recombination-based pathway of telomere maintenance. In these cells, telomerase maintains the length of the shortest telomeres. In some cases, the long heterogeneous telomeres are completely lost, and the cells now permanently contain short telomeres after only 40 population doublings. This corresponds to a telomere reduction rate of 500 base pairs/population doubling, a rate that is much faster than expected for normal telomere shortening but is consistent with the rapid telomere deletion events observed in cells using the recombination-based pathway of telomere maintenance (Murnane, J. P., Sabatier, L., Marder, B. A., and Morgan, W. F. (1994) EMBO J. 13, 4953-4962). We also observed reductions in the fraction of cells containing alternative lengthening of telomere-associated promyelocytic leukemia bodies and extrachromosomal telomere repeats; however, no alterations in the rate of sister chromatid exchange were observed. Our results demonstrate that human cells using the recombination-based pathway of telomere maintenance retain factors required for telomerase to maintain telomeres and that once the telomerase-based pathway of telomere length regulation is engaged, recombination-based elongation of telomeres can be functionally inhibited.

Chromosome Aberrations↗
PubMed1990

Protein and energy requirements for maintenance of indigenous Granadina goats.

Sixteen adult castrated male goats of the Granadina breed, with initial live weights ranging from 26.0 to 33.3 kg were used in two experiments to determine their protein and energy requirements for maintenance. Digestibility, nitrogen and energy balance measurements were made during the experiments. Two diets, which were based on pelleted lucerne (Medicago sativa) hay alone or on this forage and barley, were individually given at about maintenance level once daily. Gas exchange was measured using open-circuit respiration chambers. Fasting heat production was also determined. By regression analysis endogenous urinary N and maintenance requirements for N were estimated to be 119 mg/kg body-weight (W)0.75 per d and 409 mg total N/kg W0.75 per d respectively. Fasting heat production was 324 kJ/kg W0.75. The energy requirement for maintenance was calculated by regression of energy balance on metabolizable energy (ME) intake and a value of 443 kJ/kg W0.75 per d was found. The overall efficiency of utilization of ME for maintenance was 0.73.

Animal Feed↗
PubMedDate not supplied

Monitoring of low level arsenic exposure during maintenance of ion implanters.

To delineate potential exposure in ion implanter maintenance, the authors recruited 21 maintenance engineers (exposed group) and 10 computer programmers (controls) at three semiconductor manufacturing facilities. Samples of air, wipes, and urine; used cleaning cloths; and used gloves were collected for the characterization of arsenic exposure. Arsenic levels were very low in environmental samples, but high arsenic levels were found in some wipe samples, used cleaning cloths, and gloves. The average baseline content of urinary arsenic measured for maintenance engineers was 3.6 microg/g creatinine. Maintenance engineers experienced an increase of 1.0-7.8 microg/g creatinine in urinary arsenic levels during ion implanter maintenance. Results of a mixed-model analysis indicated that urinary arsenic levels were associated significantly with time series (p = .0001), and the extent of association was different among the three facilities (p = .0226). The results of this study indicate that arsenic intake via ingestion, rather than through inhalation, might play a significant role in the elevation of urinary arsenic levels. However, a series of urine samples with self-reference continue to be a good approach for the monitoring of low-level arsenic exposure.

Adult↗
PubMed1988

Maintenance energy requirements of laying hens: a comparison of measurements made by two methods based on indirect calorimetry.

1. The aims of this study were to compare maintenance metabolisable energy requirement estimates obtained in laying hens by two methods of respiration calorimetry, to investigate the changes in the heat production and energy retention of laying hens associated with temporarily reduced energy intake and to demonstrate the errors caused by using inappropriate values of net efficiency of energy utilisation (k) when extrapolating to maintenance energy requirement from a range of energy retention values. 2. One of the methods used regression of a range of energy retentions on energy intakes, followed by interpolation of zero energy retention; the other method employed extrapolation to zero energy retention from a single level of energy intake and retention. 3. Maintenance energy requirements derived from the two methods were similar. There was no indication that repeated temporary reduction of energy intake for the regression method gave a reduced value for maintenance energy requirement. The main potential advantage of the single-point method is therefore rapidity. 4. The single-point method relies for accuracy either on fixing an energy intake near the expected maintenance or on having a very accurate value for k. For example, the error attributable to using an assumed net efficiency (k) value of 0.7 when the true value was 0.8 was shown to vary between 0 if energy retention was measured at the equilibrium point and about 70 kJ/kgW0.75 d, or +15%, if energy retention was measured in the fasted state. 5. Stability of heat production and energy intake was approached after 2 d of reduced energy intake.

Animals↗
PubMed2005

Age-related declines in context maintenance and semantic short-term memory.

This study reports age-related declines in context maintenance (Braver et al., 2001) and semantic short-term memory (STM) and evidencc for a relation between the two. A group of younger and older adults completed a context maintenance task (AX-CPT), a semantically oriented STM task (conceptual span), a phonologically oriented STM task (digit span), and a meaning integration task (semantic anomaly judgement). In the AX-CPT task, a target response is required to the probe letter "X" but only when it is preceded by the letter "A" (the context). Either three (short interference) or six distractor letters (long interference) were presented between the cue and the probe. Results indicated an age-related deficit in context maintenance. Age-related declines were also observed for conceptual span and semantic anomaly judgement but not for digit span. Context maintenance was correlated with conceptual span and semantic anomaly judgement but not with digit span. These correlations were largely mediated by age differences, which also explained variance that was unique to (and not shared among) context maintenance, conceptual span, and semantic anomaly judgement.

Adult↗
PubMed1998

Deaths in the first two weeks of maintenance treatment in NSW in 1994: identifying cases of iatrogenic methadone toxicity.

A study was undertaken to estimate the frequency of iatrogenic methadone toxicity in the first 2 weeks of maintenance treatment in NSW. Cases were identified from a list of all 1994 methadone-associated deaths using data on methadone patients held by the NSW and Queensland Health Departments. The likely causes of death were determined from data collected from coronial files. A forensic toxicologist experienced in the area gave an independent opinion. Of the 14 deaths in the first 2 weeks of maintenance, at least 10 were primarily caused by the toxic effects of methadone prescribed by NSW doctors. The rate of fatal iatrogenic methadone toxicity was 2.2 per thousand admissions to maintenance. Victims of fatal iatrogenic toxicity often displayed signs of methadone intoxication in the days before their death. They invariably died several hours after taking the fatal dose, usually after seeming to go to sleep. Often friends or family were concerned about their welfare, were unable to rouse them from their "sleep" and frequently reported the deceased was "snoring" loudly for some time before their demise. The author recommends that patients entering methadone maintenance should be informed of the risks and should be required to give written consent to treatment. To prevent fatal methadone toxicity, patients should receive daily medical assessment during the first 1-2 weeks of maintenance.

Journal Article↗