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PubMed2006

Opioid addicts at admission vs. slow-release oral morphine, methadone, and sublingual buprenorphine maintenance treatment participants.

With use of a randomized study design, quality of life (QOL) and physical symptoms of opioid addicts at admission were compared with slow-release oral morphine, methadone, and sublingual buprenorphine maintenance program participants after 6 months of treatment. The study was conducted from February to July 2004 in the outpatient drug user treatment center at University Department of Psychiatry at Innsbruck, providing maintenance treatment programs and detoxification in Tyrol, Austria. One hundred twenty opioid users seeking treatment were compared with 120 opioid-dependent patients retained for 6 months on a slow-release oral morphine, methadone, or sublingual buprenorphine maintenance program. The German version ("Berlin Quality of Life Profile") of the Lancashire Quality of Life Profile was used, and illicit opioid use was determined by urinalysis. Physical symptoms were measured by using the Opioid Withdrawal Scale. Urinalyses revealed a significantly lower consumption of cocaine and opioids in all three substitution groups than in patients at admission (p < 0.001 and p < or = 0.004, respectively). Both the buprenorphine and the methadone maintenance group showed significantly more favorable values than opioid clients at admission for stomach cramps (p < or = 0.002), muscular tension (p < or = 0.027), general pain (p < or = 0.001), feelings of coldness (p < or = 0.000), heart pounding (p < or = 0.008), runny eyes (p < or = 0.047), and aggressions (p < or = 0.009). Patients who received slow-release oral morphine treatment generally showed the least favorable QOL scores compared with patients at admission or sublingual buprenorphine and methadone clients. Patients in the sublingual buprenorphine or methadone program showed nearly the same QOL scores. The buprenorphine and the methadone maintenance group showed significantly more favorable values than opioid clients at admission regarding leisure time (p < or = 0.019), finances (p < or = 0.014), mental health (p < or = 0.010), and overall satisfaction (p < or = 0.010). Slow-release oral morphine is a well-established treatment for pain, but more research is required to evaluate it as a treatment for heroin dependence. The present data indicate that slow-release oral morphine could have some disadvantages compared with sublingual buprenorphine and methadone in QOL, physical symptoms, and additional consumption. The results further suggest that buprenorphine treatment is as effective as methadone in effects on quality of life and physical symptoms.

Adult↗
PubMed1981

[A new method for testing the quality of food proteins for maintenance metabolism. 4. Testing of isolated proteins as well as various protein sources of plant and animal origin].

Male adult rats (370 g body weight) were fed on maintenance level (460 kJ ME/kg 0,75). In a 10 days preliminary period they received a casein/methionin diet (95,5 W/W) supplemented with 10 mg N-15-excess per 0,178 kg metabolic body weight in form of ammonium acetate. Thereafter the animals were changed on 8 isonitrogenous diets containing as protein sources casein, soya protein, gelatine, whole egg, fish meal, pea, wheat and yeast. The N-15-excretion via urine and faeces 6th and 10th day after the end of labelling period was used to evaluate the dietary proteins for maintenance. N-15 in urine was lowest in animals fed with the wheat diet and highest after feeding the whole egg diet. From these data a so called "N-15-excretions BV" was calculated, which indicated the highest quality for wheat and soy protein in meeting the needs of the intermediary metabolism in maintenance. On the other hand, dietary protein sources influence the loss of endogenous nitrogen as metabolic faecal nitrogen (MFN). It was found to be lowest in animals fed with diets containing isolated proteins (6 mg MFN/100 g body weight) and highest after feeding protein sources of plant origin with a high content in crude fibre (10 mg MFN/100 g). Both, losses of N-15 via urine and via feces were combined in a parameter called "total BV". According to this parameter the differences in quality for maintenance were only little between the protein sources testet (casein 100, soy protein 100, pea 99, wheat 99, whole egg 92, fish meal 89, gelatin 89). It was concluded that in maintenance the supply with indispensable amino acids is not critical and that the supply with dispensable amino acids (or nonspecific nitrogen) is of great importance.

Amino Acids↗
PubMed1987

Effect of protein quality on energy requirements for maintenance in growing rats.

Forty 3-week old male Wistar rats (initial weight 45-50 g) were used. After weaning they were fed ad libitum for four weeks (I to IV) on 6 isocaloric and isonitrogenous semisynthetic diets based on soya bean meal (diet SBM) or on ground lupin seed (diet LS) alone or autoclaved (A) or not at 120 degrees C and supplemented with DL-methionine (diets ALSm or LSm, respectively) or with DL-methionine + L-lysine (diets ALSm + l or LSm + l). The diets differ in their protein quality and were formulated in order to provide the adequate experimental conditions to determine the biological value (10% crude protein). Then over the fifth and sixth weeks (V and VI) the rats were fed on the same diets but restricted to 60% of the voluntary feed intake. In a parallel experiment, a group of eight rats previously fed ad libitum on diet SBM for four weeks was fasted for 72 h and then fed on the same diet at a level of intake slightly below maintenance. After a 24 h adaptation period, irrespective of the level of intake and type of diet, a series of 24 h gas-exchanges measurements were carried out in open-circuit respiration chambers. Measurements of energy balance were used to calculate ME for maintenance (MEm) and the efficiency of utilization of ME, using a linear regression of energy retention (RE) on ME. The estimates for MEm derived from energy balances of rats fed above maintenance ranged from 564 to 621 kJ/kgW0.75 per d. No significant differences between diets were observed. From pooled data MEm was found to be 599 kJ/kgW0.75 per d, a value not significantly different from that calculated from measurements at fasting and below maintenance levels (598 kJ/kgW0.75 per d). The efficiency of utilization of ME for maintenance was 81.1% and the efficiencies of utilization of ME for RE ranged from 36.6 to 59.9%. It is concluded that no variations in MEm requirements in growing rats attributable to variations in dietary protein quality have been found. Nevertheless, these results should be taken with caution because of limitations inherent of statistical modelling approaches of partitioning ME.

Animal Feed↗
PubMedDate not supplied

[The energy maintenance requirement of growing pigs of different sexes give normal and high protein diets. 2. Experiments in sows].

Six animals each out of 12 female fattening hybrids (150 X (L X E] were given rations containing 17 or 45% crude protein resp. 4 periods of growth feeding alternated with 5 periods of maintenance feeding in the live weight range between 33 and 146 kg. The feeding level did not have an influence on the level of digestibility. From the experiments with 17% crude protein in the ration 1004 and from those with 45% crude protein 947, on average 977 kJ metabolizable energy per kg LW0.62 in the maintenance periods and 980 in the growth periods were derived as maintenance requirement of metabolizable energy. These values for maintenance requirement are by 50% higher than those in previous experiments of our work team. In contrast to expectations, energy maintenance requirement did not grow due to the increase of the protein content of the rations. The utilization of metabolizable energy for retention was 73% for rations with a normal protein content and 66% for those with a high protein content. The partial utilization of metabolizable energy for fat retention was ascertained as 83% and as 49% for protein retention by means of multiply regressive evaluation.

Animal Feed↗
PubMed2004

Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study.

We conducted a retrospective, multicenter study evaluating the safety of discontinuing maintenance therapy for cryptococcal meningitis after immune reconstitution. Inclusion criteria were a previous definitive diagnosis of cryptococcal meningitis, a CD4 cell count of >100 cells/microL while receiving highly active antiretroviral therapy (HAART), and the subsequent discontinuation of maintenance therapy for cryptococcal meningitis. The primary end point was relapse of cryptococcal disease. As of July 2002, 100 patients were enrolled. When maintenance therapy was discontinued, the median CD4 cell count was 259 cells/microL and the median plasma virus load was <2.30 log10 copies/mL, and serum cryptococcal antigen was undetectable in 56 patients. During a median follow-up period of 28.4 months (range, 6.7-64.5; 262 person-years), 4 events were observed (incidence, 1.53 events per 100 person-years; 95% confidence interval, 0.42-3.92). Three of these patients had a CD4 cell count of >100 cells/microL and a positive serum cryptococcal antigen test result during the recurrent episode. In conclusion, discontinuation of maintenance therapy for cryptococcal meningitis is safe if the CD4 cell count increases to >100 cells/microL while receiving HAART. Recurrent cryptococcal infection should be suspected in patients whose serum cryptococcal antigen test results revert back to positive after discontinuation of maintenance therapy.

AIDS-Related Opportunistic Infections↗
PubMed2005

High-frequency stimulation together with adrenoceptor activation facilitates the maintenance of long-term potentiation at visual cortical inhibitory synapses.

Long-term potentiation (LTP) at inhibitory synapses of rat visual cortex requires firing of presynaptic cells for maintenance, at least at a low frequency. We examined the roles of adrenoceptors in this LTP maintenance. Although high-frequency stimulation (HFS) failed to produce LTP in normal Ca2+ medium, it produced pathway-specific LTP with addition of noradrenaline to the medium soon after HFS. However, this LTP disappeared after washout of noradrenaline. HFS applied during noradrenaline application produced LTP persisting even after washout, indicating that HFS together with adrenoceptor activation makes the adrenergic facilitation enduring. After washout, LTP was produced further by HFS of the conditioned, but not the unconditioned, pathway by the first HFS. Pharmacological examination demonstrated that alpha2 and beta, but not alpha1, receptors facilitated LTP maintenance synergistically. Bath application, but not postsynaptic loading, of either the adenylyl cyclase activator forskolin or the protein kinase C (PKC) activator phorbol ester facilitated LTP maintenance. These results suggest that adrenergic facilitation of LTP maintenance is mediated by presynaptic adrenoceptors via a subfamily of adenylyl cyclases stimulated by Gsalpha, Gibetagamma, and PKC. Thus, it is likely that the activity of noradrenergic afferents takes part in the control of LTP duration at visual cortical inhibitory synapses.

Adaptation, Physiological↗
PubMed2005

Predicting older adults' maintenance in exercise participation using an integrated social psychological model.

Little is known about the predictors of maintenance in organized exercise programmes. The aim of this study was to investigate the behavioral predictors of maintenance of exercise participation in older adults, using an integrated social psychological model. To this end, we carried out a prospective cohort study (n = 1,725; age 50 years or older) involving 10 different types of exercise programmes, with measurements at baseline and after 6 months. Predictors of intention to continue participating and the actual maintenance of exercise participation in the exercise programme were assessed using a step-wise logistic regression model. Significant odds ratios (ORs) predicting the intention to continue with the exercise programme were found for female sex, younger age, being married, being a non-smoker, being in paid employment, having a positive attitude towards exercise and having a high self-efficacy at baseline. Significant ORs predicting actual maintenance of exercise participation were short lapses, absence of lapses, high intention at baseline, high perceived quality of the programme, positive attitude at baseline and few risk situations at baseline. In order to promote maintenance of exercise participation for older adults, effort should be taken to prevent lapses, to help people cope with risk situations for lapses, to improve the attitude towards exercise participation and to improve the quality of the programme.

Aged↗
PubMedDate not supplied

Midlife women's adherence to home-based walking during maintenance.

BACKGROUND: Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. OBJECTIVE: The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. METHODS: There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. RESULTS: Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. DISCUSSION: These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

Adult↗
PubMed1991

The progression of mild acute cardiac rejection evaluated by risk factor analysis. The impact of maintenance steroids and serum creatinine.

The natural course of mild acute cardiac allograft rejection (MAR) under cyclosporine-based therapy is generally considered benign, and usually antirejection therapy is not instituted. The present study was undertaken to determine the frequency of and the risk factors for progression of MAR into a clinically significant (moderate or severe) rejection on subsequent endomyocardial biopsy (EMB). Among 167 cardiac recipients, transplanted from 3/1984 to 4/1990, MAR under cyclosporine-based therapy was diagnosed on 220 EMBs. Depending upon the outcome on the subsequent EMB, MAR was categorized as progressive or nonprogressive. This served as the dependent variable for a stepwise logistic regression analysis evaluating 11 covariates as potential risk factors: perioperative antibody prophylaxis (ATG vs. OKT3), maintenance therapy, underlying disease, HLA-mismatches for A- and B + DR-loci, serum creatinine (mg/dl) and cyclosporine HPLC blood level (ng/ml) at diagnosis of MAR and at subsequent biopsy, recipient age, donor age. 40 (18.2%) of 220 MARs became progressive as opposed to 37 (7.3%) of a control cohort of 507 negative EMBs (P less than 0.0001). Stepwise logistic regression yielded the type of maintenance therapy (P = 0.0019) and serum creatinine level at diagnosis of MAR (P = 0.0615) as independent predictors of progression of MAR. After adjustment for influence of maintenance therapy and serum creatinine none of the cyclosporine variables provided any additional information. MARs without maintenance steroids and low serum creatinine levels had the highest risk (37.2% observed incidence) to develop moderate or severe rejection on subsequent EMB. This analysis supports evidence that diagnosis of MAR on EMB is associated with a considerable high progression rate into clinically significant rejection when compared to negative EMBs. Progression particularly occurs in MAR under steroid-free maintenance therapy and suggests early augmentation of immunosuppression. In terms of progression of MAR serum creatinine values, obviously indicating cyclosporine nephrotoxicity, appear to reflect the extent of cyclosporine-mediated immunosuppressive activity more properly than parameters of its bioavailability by measuring cyclosporine HPLC blood levels.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Barriers to physical activity maintenance after cardiac rehabilitation.

PURPOSE: Little is known about the contextual determinants for the maintenance of physical activity after cardiac rehabilitation. This study aimed to examine perceived social, psychological, and health-related barriers to the maintenance of physical activity among phase 2 cardiac rehabilitation graduates. METHODS: Researchers using an open-ended format asked 160 participants (121 men and 39 women) 6 months after rehabilitation to identify perceived barriers to physical activity maintenance. The content of the participant responses was analyzed through categorization and coding of data, with independent review used to assess accuracy and reliability of decision rules. A social ecologic perspective was used for secondary coding and categorization. A chi analysis of categories was conducted to explore differences by gender, ethnicity, education, and employment. RESULTS: Four categories were developed from the coded responses: intrapersonal, interpersonal, environmental, and organizational. In their responses, 93% of the participants reported intrapersonal barriers, with 24% reporting interpersonal barriers, 18% reporting environmental barriers, and 11% reporting organizational barriers. Years of education contributed significantly to acceptance of an inactive lifestyle among those less educated (chi = 32.489; P = .028). Employment status showed significant differences for work as a barrier among those employed full-time (chi = 13.570, P = .004). Barriers to physical activity by gender showed significant differences for interpersonal barriers as a whole (chi = 6.804; P = .009). CONCLUSIONS: The open-ended format provided rich narrative data regarding barriers to the maintenance of physical activity. The acknowledgment of barriers, particularly from a social ecologic perspective, is needed to guide innovative, multilevel interventions for promoting physical activity maintenance among those with diagnosed coronary heart disease.

Adult↗
PubMed1996

The frequency and consequences of varicella exposure and varicella infection in children receiving maintenance therapy for acute lymphoblastic leukemia.

PURPOSE: The frequency and cost of varicella and varicella exposure were determined in children receiving maintenance chemotherapy for acute lymphocytic leukemia, and the cost of a preventative strategy using the varicella vaccine was estimated. PATIENTS AND METHODS: Retrospective analysis of clinic and hospital records for 472 children at 12 sites who were receiving maintenance chemotherapy on Protocol 105 of the Childrens Cancer Group. RESULTS: During a mean maintenance period of 2 1/2 years there were 120 exposures to varicella among susceptible children (10/100 patient-years). During the same period there were 60 cases of varicella (4.6/100 patient-years). Half of the cases of varicella occurred without a known exposure. Exposures and varicella resulted in significant omission or delay in chemotherapy. Total medical charges for varicella-related events were $492,000 ($470 per varicella exposure; $7,450 per case of varicella). A proposed preventative strategy using varicella vaccine after 6 months of maintenance therapy would theoretically reduce varicella-related charges by 80%. CONCLUSIONS: Varicella exposure and varicella are common in this patient population. The use of varicella vaccine during the early maintenance period should be considered to prevent these events. This strategy is likely to be safe, and will save significant medical charges, drug omission, disease-related morbidity, hospitalization, and work and school disruption.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Maintenance treatment of bipolar disorder: Applying research to clinical practice.

The authors review available controlled trials of bipolar maintenance treatment and discuss the strengths and weaknesses of various study designs. Bipolar maintenance trials are organized according to the features of their designs, such as use of responder-enriched samples; inclusion following an index manic versus an index depressive episode; outcome defined as relapse into mania, depression, or either; and use of survival analysis. Pivotal studies of lithium, divalproex, lamotrigine, olanzapine, aripiprazole, and other medications are reviewed. The directional efficacy of the different medications as maintenance treatment is discussed, with treatments differentiated in terms of whether they primarily prolong time to mania or to depression or have bidirectional effects. Also discussed are findings concerning the continuation of acute treatments, including antidepressants, into the maintenance phase; dosage adjustments for maintenance treatment; the rationale for combination treatments; and implications of comorbid substance abuse and strategies for its management. Directions for future research are suggested.

Anticonvulsants↗
PubMed2006

Steroid withdrawal for pancreas after kidney transplantation in recipients on maintenance prednisone immunosuppression.

UNLABELLED: Steroid withdrawal from patients taking prednisone for their renal allograft at the time of reinduction of immunosuppression for subsequent pancreas after kidney (PAK) transplantation has not been explored. Our expectation was that lymphocyte depletion, in conjunction with an augmentation of immunosuppression at the time of pancreas transplantation would protect the recipient from rejection of the renal allograft when chronic maintenance steroids are withdrawn. METHODS: Pancreas transplantation was performed using systemic venous drainage and enteric exocrine drainage. Regardless of preoperative immunosuppression, all patients received induction with antithymocyte globulin, a brief taper of intravenous solumedrol over four to five days, maintenance therapy with tacrolimus and sirolimus and either resumption of chronic maintenance steroids or complete withdrawal of steroids. RESULTS: A total of 30 PAK transplants were performed in 29 recipients and divided into two groups: continuation of chronic steroids (n = 10) or steroid-free (n = 19). One pancreas allograft was lost and there was a single mortality in the steroid free group. There was no significant difference in renal function or incidence of infections. CONCLUSION: Steroids can be safely withdrawn following pancreas after kidney transplantation for recipients already on maintenance prednisone in the setting of rabbit antithymocyte globulin induction and tacrolimus and sirolimus maintenance immunosuppression.

Creatine↗
PubMed2004

Slow-release oral morphine versus methadone: a crossover comparison of patient outcomes and acceptability as maintenance pharmacotherapies for opioid dependence.

AIMS: To evaluate slow-release oral morphine (SROM) as an alternative maintenance pharmacotherapy to methadone for treatment of opioid dependence. DESIGN: Open-label crossover study. SETTING: Out-patient methadone maintenance programme. PARTICIPANTS: Eighteen methadone maintenance patients. Intervention Participants were transferred from methadone to SROM (once-daily Kapanol trade mark ) for approximately 6 weeks before resuming methadone maintenance. MEASUREMENTS: Patient outcomes were assessed (1) during the transition between medications (dose requirements, withdrawal severity) and (2) after at least 4 weeks on a stable dose of each drug (treatment preference, patient ratings of treatment efficacy and acceptability, drug use, health, depression and sleep). FINDINGS: Transfer from methadone to SROM was associated with relatively mild withdrawal for the first 5 days; the final mean SROM : methadone dose ratio was 4.6 : 1. Compared to methadone, SROM was associated with improved social functioning, weight loss, fewer and less troublesome side-effects, greater drug liking, reduced heroin craving, an enhanced sense of feeling 'normal' and similar outcomes for unsanctioned drug use, depression and health. The majority of subjects preferred SROM (78%) over methadone (22%). CONCLUSIONS: These findings provide justification for further evaluation of SROM as a maintenance pharmacotherapy for opioid dependence.

Adult↗
PubMed2005

Menstrual cycle length during methadone maintenance.

AIMS: While the menstrual disruption of heroin has been demonstrated, there are few published data concerning methadone maintenance and menstrual function. This study was conducted to evaluate whether cycle length was more regular during methadone maintenance. SETTINGS: An out-patient research treatment program in Baltimore, Maryland, USA. PARTICIPANTS: A total of 191 heroin and cocaine-using women from two clinical trials, lasting 25-29 weeks; each woman was maintained on 70-100 mg of methadone. MEASUREMENTS: Start/end dates of each menses were collected. DESIGN: Menstrual patterns were classified as regular, irregular, transient amenorrhea, persistent amenorrhea or cycle restart. Repeated-measures regression modeling determined correlates of cycle length and predictors of long cycles (> 40 days) and short cycles (< 20 days). Bleeding episodes were defined as 1 or more bleeding days, bound by at least 2 non-bleeding days. Correlates/predictors examined were body mass index, drug use, methadone dose and race. FINDINGS: In the 133 women for whom menstrual patterns could be determined, cycle-length irregularity was common: irregular, 62 (46.7%); regular, 37 (27.8%); cycle restart, 16 (12%); persistent amenorrhea, 11 (8.3%); transient amenorrhea, seven (5.3%). Each additional week on methadone maintenance was associated with decreased risk of long (OR = 0.96, P < 0.01 and short (OR = 0.92, P < 0.01) cycles. Of 27 women with secondary amenorrhea pre-study, 16 (59%) restarted menses. Positivity for opioids or cocaine was not significantly associated with short or long cycles. CONCLUSIONS: Cycle length begins to normalize during methadone maintenance. Menses resumption may occur. Methadone maintenance, despite interfering with menstrual function in an absolute sense, may interfere less than illicit heroin abuse.

Adult↗
PubMed1989

Ranitidine maintenance treatment of non-steroidal anti-inflammatory drug-induced duodenal ulceration.

Fifty-six patients who presented with non-steroidal anti-inflammatory drug-associated duodenal ulcers received maintenance treatment with ranitidine. Forty-eight of these patients stopped treatment with non-steroidal anti-inflammatory drugs. The cumulative symptomatic remission at the end of 5 years of maintenance treatment was 97.7%. While half the patients had presented with haemorrhage from the ulcer, only one patient bled during maintenance treatment, giving a cumulative risk of 2.3% in 5 years of maintenance treatment. We conclude that maintenance treatment with ranitidine effectively and safely keeps patients with non-steroidal anti-inflammatory drug-associated ulcers symptom- and risk-free.

Adolescent↗
PubMed2006

Improvement in quality of life with infliximab induction and maintenance therapy in patients with moderate-to-severe psoriasis: a randomized controlled trial.

BACKGROUND: Psoriasis has a well-documented, markedly negative effect on patient quality of life. OBJECTIVES: To evaluate the impact of long-term infliximab maintenance therapy on health-related quality of life (HRQoL) in patients with psoriasis. METHODS: The Dermatology Life Quality Index (DLQI) and 36-item Short Form Health Survey (SF-36) were administered as part of the pivotal double-blind, placebo-controlled efficacy and safety EXPRESS study of infliximab in chronic plaque psoriasis. In total, 378 patients with moderate-to-severe psoriasis were enrolled at 32 centres in Europe and Canada. Patients were randomized to receive either placebo or infliximab 5 mg kg(-1) induction at weeks 0, 2 and 6 followed by maintenance every 8 weeks; placebo patients crossed over at week 24 to receive the infliximab induction and maintenance regimen. RESULTS: At week 10, infliximab-treated patients had significantly greater improvement in DLQI scores (P < 0.001) and SF-36 physical and mental component summary scores (P < 0.001) than placebo-treated patients. Significant improvement (P < 0.001) was also seen in all eight SF-36 subscales, and was greatest for the "Bodily Pain" and "Social Functioning" scales. Significant improvement in HRQoL persisted with maintenance infliximab treatment at week 24 (P < 0.001), with patients achieving a Psoriasis Area and Severity Index score of 0 reporting the greatest benefit. Treatment-related HRQoL improvement remained substantial at week 50. CONCLUSIONS: Infliximab induction and maintenance regimens resulted in rapid, substantial, sustained and clinically meaningful improvement in both dermatology-specific and general quality of life indices in patients with psoriasis, with total clearance resulting in maximum improvement.

Adult↗
PubMed1989

Long term growth and maintenance of stratified rat urothelium in vitro.

Culture conditions that allow long term growth and maintenance of rat urothelium have been determined using short (3 to 8 days) and long (14 to 60 days) term measurements of cell density and tritiated thymidine incorporation as indices. The basal nutrient medium utilized was a mixture of 199 plus Ham's F 12 (1:1) supplemented with insulin (1 microgram/ml) and hydrocortisone (1 microgram/ml). Long term culture of urothelium seems to require porous collagen. Porous albumin, or plastic dishes thinly coated with albumin, collagen, fibronectin or mixtures thereof, did not support long term maintenance. Serum was required at a concentration of 5%, independent of other additives. Decreasing Ca++ levels below that normally found the basal medium (approximately 1 X 10(-3] to as low as 1 X 10(-4), resulted in increased short term proliferation, but decreased long term maintenance by causing a loss of stratification of the urothelium. Even a slight increase in Ca++ concentration from 1.0 to 1.5 X 10(-3) resulted in an inhibition of proliferation and an increase in the number of large flat cells which subsequently sloughed off in sheets. The deletion of either insulin, hydrocortisone or both, inhibited growth. The addition of epidermal growth factor (EGF) or its homologue, transforming growth factor (TGF-alpha), increased cell proliferation markedly and caused a variable increase in stratification. However, epithelium induced to rapid growth and proliferation with EGF, eventually exhausted its growth potential and died. TGF-beta 1, alone or in combination with either EGF or alpha-TGF, had no additional effect upon urothelial growth. Repeated transfers of urothelium by enzymatic dissociation led to decreased growth and maintenance potential. The data indicates that long term maintenance of stratified urothelium in culture requires a porous collagen substrate and fetal bovine serum together with hormonal requirements and concentrations of Ca++ that neither greatly stimulate nor inhibit growth.

Animals↗