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PubMed2001

Interferon alfa 2b as maintenance therapy in poor risk diffuse large B-cell lymphoma in complete remission after intensive CHOP-BLEO regimens.

OBJECTIVES: We conducted a randomized clinical trial to evaluate the role of interferon alfa 2b (IFN) as maintenance therapy in patients with diffuse large B-cell lymphoma with high or high-intermediate clinical risk on complete remission (CR) after CHOP-BLEO regimens. METHODS: Patients were initially treated with CHOP-BLEO regimens (which include increased doses of cyclophosphamide and epirubicine, instead of doxorubicin). If the patients achieved CR they were randomly assigned to receive either maintenance therapy with IFN 5.0 MU, three times at week by 1 yr, or no treatment (control group). RESULTS: Two hundred and twenty-three patients were considered as candidates for the study. They were of high (80%) or high-intermediate (20%) clinical risk; additionaly most patients had poor prognostic factors such as high levels of beta 2 microglobulin, lactic dehydrogenase levels, bulky disease (defined as a tumor mass >10 cm) or multiple extranodal involvement. In an intent-to-treat analysis all patients were evaluable to efficacy and toxicity. Median follow-up was 45 months, the estimated 5-yr overall survival and event-free survival (EFS) for patients who received IFN were 71% (95% confidence interval (CI): 61-83%) and 57% (95% CI: 39-69%), respectively, values which were not statistically different from the control group: 69% (95% CI: 63-79%) and 54% (95% CI: 37-63%), respectively (p=0.2). Toxicity was mild. CONCLUSIONS: These results suggest that IFN used as maintenance therapy at these doses and schedules is not useful in aggressive malignant lymphoma when more intensive chemotherapy has been employed during induction treatment. Nevertheless, follow-up is too short, and long-term follow-up would be necessary in order to draw definitive conclusions. Probably, an multicenter study is necessary to define the role of IFN as maintenance therapy in this patient setting.

Actuarial Analysis↗
PubMed2003

Changes in gingival crevicular fluid matrix metalloproteinase-8 levels during periodontal treatment and maintenance.

OBJECTIVES: The aim of this study was to investigate the effect of scaling and root planing (SRP) and the maintenance phase of treatment on the gingival crevicular fluid (GCF) matrix metalloproteinase-8 (MMP-8) levels. MATERIALS AND METHODS: Clinical measurements and GCF samples were taken from four sites in 20 adult periodontitis patients before and after SRP and during a 3-month maintenance phase of treatment. MMP-8 levels were measured from GCF samples by time-resolved immunofluorometric assay (IFMA) with monoclonal antibodies. RESULTS: SRP improved the clinical indices as would be predicted, 6.1 mm (SD = 1.4) at baseline compared with 4.3 mm (SD = 1.6) post-treatment (P < 0.001). Attachment level (AL) reduced but not significantly between these two visits 13.4 mm (SD = 2.4) compared with 12.8 mm (SD = 2.4) (P < 0.08) post therapy. GCF MMP-8 levels reduced after initial treatment from 33.8 micro g/30 s sample to 23.5 micro g/30 s, which just failed to reach statistical significance (P = 0.07). However, when MMP-8 levels were expressed as a concentration, the differences following initial therapy were significant (54.1 ng/ micro L at baseline compared with 34.2 ng/micro L post treatment; P < 0.005). The difference, however, between the baseline MMP-8 levels (33.8 ng/30 s) and the final visit (16 ng/30 s) following maintenance was markedly significant (P < 0.001) for both absolute amounts and on a concentration basis. CONCLUSION: In conclusion, clinical improvement following SRP was associated with significant reductions in MMP-8 levels. The GCF concentration of MMP-8 decreased after initial therapy but reduced even more dramatically (approximately 50%) following a 3-month period of maintenance (P < 0.001).

Adult↗
PubMed2004

Cognitive-behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression.

Although the efficacy of maintenance pharmacotherapy for the prevention of recurrence in major depressive disorder (MDD) is well documented, few studies have tested the efficacy of psychotherapy as a maintenance treatment. The authors examined the efficacy of the cognitive-behavioral analysis system of psychotherapy (CBASP) as a maintenance treatment for chronic forms of MDD. Eighty-two patients who had responded to acute and continuation phase CBASP were randomized to monthly CBASP or assessment only for 1 year. Significantly fewer patients in the CBASP than assessment only condition experienced a recurrence. The 2 conditions also differed significantly on change in depressive symptoms over time. These findings support the use of CBASP as a maintenance treatment for chronic forms of MDD.

Adolescent↗
PubMed2002

Risk and maintenance factors for eating pathology: a meta-analytic review.

This meta-analytic review of prospective and experimental studies reveals that several accepted risk factors for eating pathology have not received empirical support (e.g., sexual abuse) or have received contradictory support (e.g.. dieting). There was consistent support for less-accepted risk factors(e.g., thin-ideal internalization) as well as emerging evidence for variables that potentiate and mitigate the effects of risk factors(e.g., social support) and factors that predict eating pathology maintenance(e.g., negative affect). In addition, certain multivariate etiologic and maintenance models received preliminary support. However, the predictive power of individual risk and maintenance factors was limited, suggesting it will be important to search for additional risk and maintenance factors, develop more comprehensive multivariate models, and address methodological limitations that attenuate effects.

Adolescent↗
PubMed2000

Cross-cutting themes in maintenance of behavior change.

This article reviews the cross-cutting themes and research recommendations that emerged from the National Heart, Lung, and Blood Institute "Maintenance of Behavior Change in Cardiorespiratory Risk Reduction" conference. Throughout the conference participants emphasized that maintenance should be conceptualized as a process rather than merely as the last step in the behavior change process. Researchers should focus on understanding how those who are successful at long-term maintenance complete this process and on developing new approaches that can be used to help those who are not successful. Further attention to the following topics was encouraged: observational studies of the natural history of successful long-term behavior change, development of new technologies for measuring health behaviors, better theoretical understanding of the differences between initial behavior change and maintenance, development of strategies to increase participation rates and long-term effectiveness of formal treatment programs, new approaches to increase the effectiveness of self-help interventions, and better understanding of the development of behavioral patterns in children and adolescents.

Adolescent↗
PubMed2005

Representations of early family relationships predict marital maintenance during the transition to parenthood.

Marital maintenance, which involves engaging in behaviors that maintain closeness and is critical to sustaining marital satisfaction, was examined in 234 husbands and wives across the transition to parenthood. Prenatal assessments of adults' attachment representations and memories of their parents' marriage during childhood predicted perceptions of maintenance in their own marriage prenatally and 24 months postpartum. Adults who dismiss the importance of early attachment and lack believable memories of their parents' marriage reported the lowest levels of prenatal maintenance. Adults who are preoccupied with their early relationships with parents and have negative memories of their parents' marriage reported the sharpest declines in maintenance postpartum. Family interventions that can help couples recognize and explore problems that may accompany parenthood are discussed.

Adult↗
PubMed2006

Health correlates of pathological gambling in a methadone maintenance clinic.

This study compared methadone maintenance patients with and without pathological gambling (n = 167). Participants completed a self-report survey assessing lifetime pathological gambling and past-2-month gambling behavior, and they completed the SF-12v2 Health Survey, a measure of current mental and physical health. In the sample, 52.7% were classified as lifetime pathological gamblers, and the majority of pathological gamblers were actively gambling within the past 2 months. Multivariate analysis of covariance revealed that methadone maintenance patients with pathological gambling had significantly poorer mental and physical health than methadone maintenance patients without pathological gambling. These results suggest that pathological gamblers receiving methadone maintenance may benefit from additional psychosocial services. In fact, most pathological gamblers in the sample expressed interest in gambling-related services. These results extend previous research in other populations that has found that pathological gamblers report poorer mental and physical health than nonpathological gamblers.

Behavior, Addictive↗
PubMed1994

The human X-inactivation centre is not required for maintenance of X-chromosome inactivation.

X-chromosome inactivation occurs early in mammalian female development to achieve dosage compensation with males. Although it is widely accepted that this inactivation requires the presence in cis of the X-inactivation centre (XIC), it is not known whether the XIC is required for the initiation, promulgation or maintenance of X inactivation. The XIST gene, which is localized within the XIC interval on both the human and mouse X chromosomes, is constitutively expressed from inactive X chromosomes, suggesting a possible role in the maintenance of X inactivation. To address whether the presence of the XIC, including the XIST gene, is continuously required for the maintenance of X-chromosome inactivation, we have analysed the transcriptional activity of a number of X-linked genes in mouse/human somatic cell hybrids retaining an intact human inactive X chromosome or derivatives of the inactive X chromosome lacking the XIC. Genes subject to X inactivation remain transcriptionally silent despite the loss of the XIC, demonstrating that the presence of the XIC is not required for the maintenance of X inactivation in somatic cells.

Animals↗
PubMed1990

The maintenance of busulphan-induced remissions in chronic granulocytic leukaemia with recombinant interferon alpha-2b.

Interferon (IFN) shows no specificity in inhibiting the growth of colonies of myeloid leukaemia blasts in culture as compared to normal haemopoietic precursors, but does reduce the self-renewal capacity of myeloblasts. We have tested the ability of IFN to slow the leukocyte doubling time (Ldt) and to prolong remissions induced by busulphan in 14 patients with chronic granulocytic leukaemia (CGL). Patients served as their own controls; the Ldt during relapse from a busulphan-induced remission on no therapy was determined and compared with the Ldt on IFN maintenance therapy. The initial dose of IFN (2 x 10(6) U M-2 subcutaneously, three times per week) was adjusted up, or down, to prevent the leukocyte count from rising and the platelet count from falling below 75 x 10(9) l-1. The dose of IFN required to prevent relapse in seven patients ranged from 1 x 10(6) U M-2 three times per week to 5.2 x 10(6) U M-2 daily, with a median of 2 x 10(6) U M-2 three times per week. IFN maintenance therapy has prevented relapse in six patients for more than 22 months to more than 68 months. In five patients the Ldt was slowed initially but the disease later progressed in four patients to enter the accelerated (three patients) or blast phase (one patient). The Ldt during IFN therapy did not change from the Ldt on no therapy in one patient; this patient later progressed to the blast phase. In two additional patients the leukaemia progressed during the first course of IFN, with shortening of the Ldt; both of these patients entered the blast phase. In the four patients who have discontinued IFN following relapse in the chronic phase, the Ldt remained prolonged for at least one relapse after the IFN was stopped. IFN maintenance therapy failed to control the leukocyte count in the six patients with a control Ldt of less than 40 days and five of these have progressed to enter the accelerated or blast phase. The early survival of this group of patients resembles the survival of 'good risk' CGL patients reported by others. We conclude that IFN maintenance therapy does alter the relapse pattern of a subset of CGL patients, either slowing the Ldt or preventing relapse.

Adult↗
PubMed1988

Outcome of patients with human immunodeficiency virus on maintenance hemodialysis.

Fifty-one adults with HIV infection, including 20 chronic hemodialysis patients with superimposed HIV infection and 31 patients with HIV-associated nephropathy requiring chronic maintenance hemodialysis were followed to evaluate survival on outpatient dialysis in relation to the clinical stage of the HIV infection. Regardless of when they contracted the infection, AIDS patients who required maintenance hemodialysis had a poor prognosis. All 17 patients who developed AIDS died after a mean of 93 +/- 32 days on hemodialysis (median 30 days; range 2 to 540 days). On the other hand, 12 asymptomatic HIV carriers were alive after a mean follow-up on chronic hemodialysis of 488 +/- 75 days (median 420 days; range 142 to 850 days); and five hemodialyzed patients with ARC were alive after 564 +/- 191 days (median 420 days; range 150 to 1230 days). The data confirm the lack of effectiveness of maintenance hemodialysis for prolonging life in patients with AIDS. This dismal prognosis was evident whether renal failure antedated HIV infection or whether it was HIV-associated. In asymptomatic HIV carriers and in patients with ARC, however, maintenance hemodialysis provides meaningful, long-term life support.

AIDS-Related Complex↗
PubMed2004

Effect of internet support on the long-term maintenance of weight loss.

OBJECTIVE: To investigate the efficacy of an Internet weight maintenance program. RESEARCH METHODS AND PROCEDURES: Two hundred fifty-five healthy overweight and obese adults (mean +/- SD BMI, 31.8 +/- 4.1 kg/m(2)) men (18%; mean +/- SD age, 45.8 +/- 8.9 yrs) participated in a 6-month behavioral weight control program conducted over interactive television. Treatment was followed by a 12-month weight maintenance program with three conditions: frequent in-person support (F-IPS), minimal in-person support (M-IPS) and internet support (IS). Main outcome measures included body weight, program adherence, and social influence components. RESULTS: There were no significant differences among the groups in weight loss (mean +/- SD) from baseline to 18 months (7.6 +/- 7.3 kg vs. 5.5 +/- 8.9 kg vs. 5.1 +/- 6.5 kg, p = 0.23 for the IS, M-IPS, and F-IPS, respectively). DISCUSSION: Participants assigned to an internet-based weight maintenance program sustained comparable weight loss over 18 months compared with individuals who continued to meet face-to-face. Therefore, the internet appears to be a viable medium for promoting long-term weight maintenance.

Adult↗
PubMed2005

Predictors of long-term weight maintenance.

OBJECTIVE: The purpose of this study was to evaluate available variables of a long-term weight maintenance study to investigate possible factors predisposing to weight regain after a period of weight loss. RESEARCH METHODS AND PROCEDURES: The Maastricht Weight Maintenance Study is an ongoing longitudinal study of healthy men and women (29 men and 62 women; 18 to 65 years of age; BMI = 30.2 +/- 3.1 kg/m(2)). A variety of parameters were measured before and after a very-low-energy diet and after a follow-up of at least 2 years. RESULTS: Mean weight loss was 7.9 +/- 3.6 kg, and percent weight regain was 113.8 +/- 98.1%. Percent BMI regain was negatively associated with an increase in dietary restraint (r = -0.47, p < 0.05). Percent weight regain was negatively correlated with baseline resting metabolic rate (r = -0.38, p = 0.01) and baseline fat mass (r = -0.24, p = 0.05) and positively correlated with the magnitude of change in body weight (BW) expressed as maximum amplitude of BW (r = 0.21, p < 0.05). In addition, amplitude of BW was positively correlated with the frequency of dieting (r = 0.57, p < 0.01). DISCUSSION: The best predictors for weight maintenance after weight loss were an increase in dietary restraint during weight loss, a high baseline resting metabolic rate, a relatively high baseline fat mass favoring a fat-free mass-sparing effect during weight loss, a rather stable BW, and a low frequency of dieting. Therefore, BW maintenance after BW loss seems to be a multifactorial issue, including mechanisms that regulate an individuals' energy expenditure, body composition, and eating behavior in such a way that energy homeostasis is maintained.

Adolescent↗
PubMed1997

Complications and maintenance requirements of implant-supported prostheses provided in a UK dental hospital.

AIM: To assess the nature, timing and frequency of complications associated with implant therapy and to assess maintenance requirements of implant-supported prostheses. DESIGN: Retrospective analysis. SETTING: The Dental Hospital in Newcastle upon Tyne. METHOD: Dental records of 60 patients provided with implant-supported prostheses were examined. Data were compiled on the number of fixtures placed per patient, the type of prosthesis provided, complications during the surgical and prosthodontic phases, and peri-implant soft tissue complications. RESULTS: 66 prostheses were placed on 236 fixtures over a 6-year period. Surgical complications included fixture loss (n = 6), dysaesthesia (n = 12), and the need for a guided tissue regeneration procedure (n = 10). Common maintenance requirements were tightening of components (n = 11), clip replacement (n = 7) and repair of conventional prostheses opposing implant supported prostheses (n = 7). Plaque control was unsatisfactory with almost half of the subjects requiring intensive oral hygiene instruction and scaling at the first post placement review. CONCLUSIONS: Prosthodontic maintenance requirements were high, particularly during the first year. Surgical complications were relatively infrequent. A case was made for a rigorous oral hygiene programme to reduce the potential for fixture loss through neglect. The financial cost associated with the maintenance of implant-supported prostheses should be incorporated in their overall funding.

Dental Clasps↗
PubMed1997

Enhanced maintenance and retroviral transduction of primitive hematopoietic progenitor cells using a novel three-dimensional culture system.

Current techniques for the in vitro maintenance of hematopoietic stem cells often lead to loss of pluripotency. Overcoming the technical difficulties that result in alterations in stem cells in vitro has important implications for areas of basic science and clinical medicine such as cell expansion, bone marrow transplantation and gene therapy. Recent insights into hematopoietic stem cell biology have demonstrated that the three-dimensional architecture of the culture environment may influence the maintenance of stem cell pluripotency in vitro. An intriguing hypothesis is that the utilization of three-dimensional culture systems may improve the maintenance and manipulation of these cells in vitro. We report that a novel, three-dimensional, tantalum-coated porous biomaterial (TCPB) may be employed effectively as a hematopoietic progenitor cell culture device that offers distinct advantages over conventional culture systems. Specifically, we demonstrate that the use of TCPB for culturing hematopoietic progenitor cells in the absence of exogenous cytokines results in enhanced hematopoietic progenitor cell survival, improved maintenance of the immature CD34+/38- phenotype, and improved retroviral transduction of CD34+ cells and long-term culture initiating cells (LTCIC), without compromising multipotency, as compared with cultures in plastic dishes or bone marrow stroma. These findings suggest that this three-dimensional culture system may be useful in advancing the in vitro culture and transduction of hematopoietic stem and progenitor cells.

Animals↗
PubMed1998

Determinants of weight maintenance in women after diet-induced weight reduction.

OBJECTIVE: Assessment of determinants for relatively successful weight maintenance in women after diet-induced weight reduction. DESIGN: Subjects followed two weight cycles over two years, each cycle starting with a Very Low Energy Diet (VLED) (2.8 MJ/d), in a free-living situation. They completed the Herman Polivy Restraint Questionnaire and the Three Factor Eating Questionnaire twice, that is, before and during the first VLED. SUBJECTS: Twenty seven obese women, body mass index (BMI) (28-38 kg/m2), age (19-53 y), being premenopausal and healthy, participated twice in the energy restriction periods with one year follow-up. MEASUREMENTS: Weight and body composition were measured at weeks 0, 8, 60, 68 and 120 after the start of the first VLED. Scores on the restraint scales before and during the first VLED were analysed. Percentages regain after one year and after two years follow-up were related to these scores. RESULTS: Three groups appeared with respect to success regarding weight maintenance. Group 1 (successful): twice a regain < 50% of weight loss; group 2 (partly successful): once a regain < 50% of weight loss and group 3 (unsuccessful): twice a regain of > 50% of weight loss. Percentage regain was negatively correlated to an increase in cognitive restrained eating behaviour (r = 0.8; P = 0.0001). A change in attitude with respect to food intake, expressed as an increase in cognitive restraint, and as a positive relationship between cognitive restraint and disinhibition was related to successful weight maintenance. CONCLUSION: An increase in cognitive restraint from before, to during, the diet, and a positive correlation between cognitive restraint and disinhibition, are two determinants representing eating behaviour for successful weight maintenance.

Adult↗
PubMed1999

Eating control and physical activity as determinants of short-term weight maintenance after a very-low-calorie diet among obese women.

OBJECTIVE: To test the hypothesis that eating control and physical activity help maintain weight and waist circumference after a very-low-calorie diet. DESIGN: A 12 week weight reduction (WR) phase, followed by a 40 week weight maintenance (WM) phase. For the latter, the subjects were randomised into a no-exercise group and one of two groups with a walking program. SUBJECTS: Eighty-five obese (body mass index 29-46, mean 34), clinically healthy, premenopausal women. MEASUREMENTS: Body weight, waist circumference, body composition, the measuring restrained eating, disinhibition and hunger, measured by Three Factor Eating Questionnaire (TFEQ), binge eating measured by the Bulimic Investigatory Test of Edinburgh (BITE), and number of daily steps measured by a pedometer. RESULTS: The change (delta) in weight during WM was predicted by the following regression: deltaweight (kg)=5.23+0.45 deltaweight during WR+0.66 disinhibition during WM0.00039 daily steps during WM, r2=0.46, SEE 3.3 kg. The change in waist circumference during WM was predicted as deltawaist (cm)=0.76+0.75 deltaweight during WM0.00021 daily steps during WM, r2=0.67, SEE 2.6 cm. Exercise group assignment did not affect the changes in weight, waist circumference, or indicators of eating control during the maintenance program. CONCLUSIONS: Control of overeating, as indicated by a lower disinhibition factor of the TFEQ, and daily physical activity, as indicated by a higher number of daily steps, were positive and independent predictors of weight maintenance after a very-low-calorie diet. The number of daily steps showed an independent association with change in waist circumference during weight maintenance, even after adjustment for weight change.

Adult↗
PubMed2002

Effects of walking or resistance training on weight loss maintenance in obese, middle-aged men: a randomized trial.

OBJECTIVE: To investigate whether walking or resistance training improves weight maintenance after weight loss when added to dietary counselling. DESIGN: Two months' weight reduction with very-low-energy-diet (VLED) followed by randomization into three groups (control, walking, resistance training) for 6 months' weight maintenance (WM) program and 23 months' unsupervised follow-up. During VLED and WM all groups received similar dietary counselling. SUBJECTS: The main inclusion criteria were BMI >30 kg/m(2), waist>100 cm and physical inactivity (exercise < or = once a week). Ninety healthy, obese (mean BMI 32.9 kg/m(2) and waist 112.5 cm), 35-50 y-old men started the study and 68 were measured at the end of the study. MEASUREMENTS: Weight and body composition assessed by underwater weighing. Exercise diaries and dietary records to assess energy balance. RESULTS: During VLED the mean body weight decreased from 106.0 (s.d. 9.9) kg to 91.7 (9.4) kg. Weight was regained mostly during follow-up and in the end of the study the mean weight in groups was 99.9-102.0 kg. Exercise training did not improve short or long-term weight maintenance when compared to the control group. However, resistance training attenuated the regain of body fat mass during WM (P=0.0l), but not during follow-up. In the combined groups the estimated total energy expenditure (EE) of reported physical activity was associated with less weight regain during WM. EE of 10.1 MJ/week was associated with maintaining weight after weight loss. EE of physical activity tended to decrease after WM in exercise groups due to poor long-term adherence to prescribed exercise. Energy intake seemed to increase during follow-up. CONCLUSION: Exercise training of moderate dose did not seem to improve long-term weight maintenance because of poor adherence to prescribed exercise.

Adult↗
PubMed2000

Low-dose cytarabine maintenance therapy vs observation after remission induction in advanced acute myeloid leukemia: an Eastern Cooperative Oncology Group Trial (E5483).

The Eastern Cooperative Oncology Group (ECOG) conducted a prospective phase III study in patients with relapsed/refractory acute myeloid leukemia (AML) to evaluate whether administration of repeated courses of low-dose cytarabine (LDAC) maintenance therapy after induction of complete remission in advanced AML would improve disease-free and overall survival. Patients with AML in second/later relapse or refractory disease were first treated with a combination of high-dose cytarabine and amsacrine. Those who achieved complete remission were then randomized to observation or to receive LDAC, 10 mg/m2 subcutaneously twice a day x2 21 days every 2 months until relapse occurred. Of 86 patients eligible for randomization, 41 patients were assigned to receive LDAC and 45 patients to observation. The median disease-free survival was 7.4 months for patients assigned to LDAC compared to 3.3 months for patients receiving no additional therapy, P= 0.084. The median survival from randomization was 10.9 months and 7.0 months for patients receiving LDAC maintenance chemotherapy and observation, respectively (P= 0.615). The data from this study suggest that LDAC maintenance therapy given to patients with advanced AML who achieve complete remission can increase disease-free survival compared to observation, but does not improve overall survival. Nevertheless, because of the ineffectiveness and toxicity of intensive post-remission chemotherapy in this circumstance, LDAC maintenance therapy, a tolerable outpatient regimen, offers the potential for improved quality of life.

Acute Disease↗