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PubMed1993

The same photoperiodic clock may control induction and maintenance of diapause in the spider mite Tetranchus urticae.

In the spider mite Tetranychus urticae, both diapause induction (which takes place during the larval and nymphal stages) and diapause maintenance (in the adult female) are under photoperiodic control. The question of whether or not the same photoperiodic clock is involved in both photoperiodic reactions was investigated in eight strains of the spider mite, originating from different localities in Europe. The methods employed consisted of (1) determination of the relative importance of the photophase and scotophase in the two photoperiodic reactions; (2) comparison of photoperiodic response curves for diapause induction and diapause maintenance; and (3) determination of the effect of light breaks on the capacity of long nights to maintain diapause, and comparison with the effect of light breaks in diapause induction experiments. The scotophase appeared to be much more important than the photophase for both diapause induction and diapause maintenance. In all strains the critical daylength for diapause maintenance, measured at the moment of saturation of the response to long daylengths, was identical to the critical daylength for diapause induction. However, the critical daylength for diapause maintenance appeared to be labile; it shifted gradually to shorter values as the mites were kept in the cold for a longer period of time, or were kept at a higher temperature for a progressively longer period of time after their stay in the cold room. This seems to reflect a gradual loss of photoperiodic control of diapause maintenance as diapause development proceeds. Photoperiods close to the critical daylength appeared to be less strong with regard to diapause maintenance than shorter daylengths. Quantitative differences in the "strength" of different daylengths were found in all strains investigated. Interruption of the night by short pulses of light revealed either one or two peaks of sensitivity in the night, or one broad "trough" where the two peaks had merged. However, in each case maximal sensitivity to the light breaks occurred at the same position in the night for diapause induction and diapause maintenance. The many similarities found lead to the conclusion that most probably the same photoperiodic clock mechanism is involved in both diapause induction and diapause maintenance in T. urticae.

Animals↗
PubMed1987

[Occupational radiation exposures during maintenance activities at nuclear power plants].

Occupational exposures at nuclear power plants occur mostly during maintenance activities rather than during routine reactor operation. In this paper, statistical summaries of occupational exposures during routine maintenance activities for the years 1982-84 at nuclear power plants in Japan are presented, including comparison of the exposure levels by reactor type and by plant age. Average annual collective doses per reactor for BWRs and PWRs are 7.30 man-Sv and 2.84 man-Sv, respectively, and 78% and 89% of annual doses are incurred during maintenance activities. Average annual outage days of BWRs and PWRs for routine maintenance are 102 d and 97 d. Annual collective doses per reactor, most of which occur during maintenance activities, usually increase with plant age. Higher collective doses are observed for routine maintenance performed on older reactors as compared to newer reactors, especially in BWRs. Collective doses accrued during respective routine maintenance activities have a significant correlation with duration of maintenance and number of workers involved in maintenance.

Environmental Exposure↗
PubMed2002

Safe interruption of maintenance therapy against previous infection with four common HIV-associated opportunistic pathogens during potent antiretroviral therapy.

BACKGROUND: The safety of interrupting maintenance therapy for previous opportunistic infections other than Pneumocystis carinii pneumonia among patients with HIV infection who respond to potent antiretroviral therapy has not been well documented. OBJECTIVE: To assess the safety of interrupting maintenance therapy for cytomegalovirus (CMV) end-organ disease, disseminated Mycobacterium avium complex (MAC) infection, cerebral toxoplasmosis, and extrapulmonary cryptococcosis in patients receiving antiretroviral therapy. DESIGN: Observational study. SETTING: Seven European HIV cohorts. PATIENTS: 358 patients taking potent antiretroviral therapy (> or =3 drugs) who interrupted maintenance therapy at a CD4 lymphocyte count greater than 50 x 10(6) cells/L. MEASUREMENTS: Recurrence of opportunistic infection after interruption of maintenance therapy. RESULTS: 379 interruptions of maintenance therapy were identified: 162 for CMV disease, 103 for MAC infection, 75 for toxoplasmosis, and 39 for cryptococcosis. During 781 person-years of follow-up, five patients had relapse. Two relapses (one of CMV disease and one of MAC infection) were diagnosed after maintenance therapy was interrupted when the CD4 lymphocyte count was less than 100 x 10(6) cells/L or when only one recent measurement exceeded this value. Two relapses (one of CMV disease and one of MAC infection) were diagnosed after maintenance therapy was interrupted once CD4 counts were greater than 100 x 10(6) cells/L for 10 and 8 months, respectively. One relapse (toxoplasmosis) was diagnosed after maintenance therapy interruption at a CD4 lymphocyte count greater than 200 x 10(6) cells/L for 15 months. The overall incidences of recurrent CMV disease, MAC infection, toxoplasmosis, and cryptococcosis were 0.54 per 100 person-years (95% CI, 0.07 to 1.95 per 100 person-years), 0.90 per 100 person-years (CI, 0.11 to 3.25 per 100 person-years), 0.84 per 100 person-years (CI, 0.02 to 4.68 per 100 person-years), and 0.00 per 100 person-years (CI, 0.00 to 5.27 per 100 person-years), respectively. CONCLUSION: Maintenance therapy against previous infection with CMV, MAC, Toxoplasma gondii, or Cryptococcus neoformans in patients with HIV infection can be interrupted after sustained CD4 count increases to greater than 200 (or possibly 100 to 200) x 10(6) cells/L for at least 6 months after the start of potent antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed1988

Health maintenance activities of physicians and nonphysicians.

Studying the health maintenance attitudes and behaviors of physicians (MDs) as patients provides information about health maintenance care in a group of individuals where preventive care might flourish. The present study reports the results of a survey of such attitudes and behaviors among 144 university-based MDs and 283 nonphysician doctoral faculty members (non-MDs) from two area universities regarding their personal health maintenance care in 1983. Respondents who reported having a personal MD (44% MDs, 74% non-MDs) were twice as likely to believe they should visit a physician regularly for health maintenance and three times as likely to actually visit a physician for health maintenance as those respondents without a personal physician. Both MDs and non-MDs described the need to visit the doctor more often than they actually reported doing so for health maintenance. However, MDs more often than non-MDs reported receiving the particular health maintenance procedures that are generally considered to constitute essential health maintenance care. A better understanding of health maintenance care by MDs and their non-MD colleagues provides insights into the use and misuse of clinical procedures in the asymptomatic adult.

Attitude of Health Personnel↗
PubMed1996

Buprenorphine, morphine and naloxone effects during ascending morphine maintenance in humans.

One purpose of this study was to characterize the acute effects of the partial mu-opioid agonist buprenorphine administered to human subjects undergoing maintenance treatment with ascending doses of morphine. A second purpose was to examine the development of tolerance, cross-tolerance and physical dependence under the same morphine maintenance conditions. Six opioid-dependent volunteers were treated chronically with ascending morphine doses of 15, 30, 60 and 120 mg/day. Each morphine dosing level was maintained for 2 weeks, with test drugs administered during the second week of maintenance of each morphine dose. Both morphine (30 mg i.m.) and buprenorphine (6 mg i.m.) constricted pupils and produced reports of opioid-like subjective effects. The magnitude of these effects was inversely related to the morphine maintenance dose, with no effects being detected at higher maintenance levels. Naloxone (0.3 mg) produced little effect at lower morphine maintenance doses but precipitated withdrawal at higher maintenance doses. Buprenorphine failed to precipitate withdrawal even when subjects were treated with 120 mg/day morphine. These findings indicate that dose-dependent tolerance to morphine, cross-tolerance to buprenorphine and physical dependence develop during morphine maintenance. The finding that buprenorphine does not act as an antagonist under these dosing conditions further supports the clinical observation that there are conditions under which patients dependent on short-acting opioids can be comfortably transferred directly to buprenorphine maintenance treatment.

Adult↗
PubMed1998

[Maintenance chemotherapy in small cell lung cancer: reasons for not using it].

There is no consensus as the optimal duration for treatment in patients with small-cell lung cancer. In routine practice, 6 cycles of chemotherapy are usually delivered, but the rate of recurrence after achieving objective response has incited interest in several trials aimed at evaluating the effect of prolonged "maintenance" chemotherapy. Such prolonged regimens may use the same drugs as used in the induction protocol or call upon new drugs. No conclusion can be drawn from the 14 randomized studies conducted to date because of differences in the randomized populations as well as the nature of the treatments tested. Among 9 trials using a maintenance regimen with the same drugs as the induction protocol, there has been no significant difference in long-term survival. One study even found a lower 2-year survival with maintenance therapy. Among 5 trials where the maintenance protocol used drugs different from the induction protocol, survival rate favored maintenance chemotherapy in only 1. Most authors have observed a significant deterioration in quality of life in patients given maintenance chemotherapy, in addition to a number of deaths due to drug toxicity. Patient recruitment had to be interrupted in one study. The percentage of patients who received the entire maintenance protocol was also very low in many trials (20%). There may exit a theoretical advantage to giving maintenance chemotherapy, but does it counterbalance the risk of late complications? An increased risk of a second cancer has been demonstrated in patients given more than 6 cycles in the National Registry of long-term survival. Given the current state of our knowledge, it would not appear reasonable to propose maintenance chemotherapy for patients with small-cell lung cancer outside controlled clinical trial protocols.

Antineoplastic Agents↗
PubMed1976

Metabolic indices for evaluating the in vitro maintenance of Hymenolepis diminuta in the presence and absence of various additives.

An in vitro maintenance system for H. diminuta was devised by modifying the cultivation procedure of Schiller (1965). In this diphasic maintenance system, tissue culture medium (Triple Eagle's or NCTC-135) was used, in lieu of whole blood, as the 30% supplement to the agar phase. This provides a more defined system suitable for studying the effects of various additives. Morphological criteria were established which aided in assessing the efficacy of media used for the maintenance of 6- and 8-day-old H. diminuta. When successfully maintained, worms exhibited an intact scolex and neck region, undulatory movements along the strobila as well as integumentary and strobilar integrity. A more sensitive method for evaluating the maintenance of 8-day-old worms employed metabolic indices. Wet weight, protein and glycogen levels for 8-day-old H. diminuta served as base-line data allowing estimation of protein and glycogen contents of each worm prior to maintenance. Following maintenance, ratio of final to initial protein and final to initial glycogen levels (metabolic indices). A metabolic index approaching or exceeding unity suggested a reasonably intact metabolism. The addition of sodium taurocholate to the maintenance media appeared beneficial to the worms by prolonging the retention of normal signs. A combination of additives, taurocholate-nucleosides-lipids, improved the maintenance of H. diminuta for periods exceeding 24 hr as determined by observational criteria and metabolic indices. However, addition of a lipid mixture, or a lipid mixture prepared with a low concentration of taurocholate was not beneficial over a 24 hr period. The maintenance system, observational criteria, base-line data and metabolic indices should be useful for future in vitro studies requiring long-term incubation.

Animals↗
PubMed1990

Maintenance of cooling towers following two outbreaks of Legionnaires' disease in a city.

This survey assessed the maintenance of evaporative cooling towers in Glasgow, following two Legionnaires' disease outbreaks. Information was obtained from 76 of 81 premises and a maintenance score was calculated for each of 174 towers. The quality of maintenance was extremely varied (range of maintenance scores, 8-30; mean, 22 (S.D., 5.0); median, 23; maximum possible, 33) and some towers were neglected. Breaches of maintenance principles were mainly structural and organizational, e.g. inadequate drift control, rather than failure to use chemicals. Low maintenance scores were associated with no log book, no guidelines, no change in procedures in last 5 years, solitary cooling towers, and towers on industrial premises. Despite intense publicity the standard of cooling tower maintenance in Glasgow remained a concern. Information campaigns directed at those responsible for cooling-tower maintenance are necessary.

Air Conditioning↗
PubMed2002

Failure of timed bright light exposure to alleviate age-related sleep maintenance insomnia.

OBJECTIVES: To determine whether a twice-weekly maintenance schedule of evening bright light exposure is effective in alleviating sleep maintenance insomnia on a long-term basis, after the establishment of a more favorable phase relationship between the core body temperature (CBT) rhythm and sleep. DESIGN: Subjects underwent light treatment while living at home. Eleven to 13 consecutive days of acute light treatment (active) were followed by a 3-month maintenance light treatment period (active or control). Subjects completed five laboratory sessions: before and after the acute phase and once a month during the maintenance period. SETTING: Sleep laboratory and subjects' homes. PARTICIPANTS: Fifteen older subjects (seven women, eight men; aged 63-84) with chronic (>1 year) complaints of sleep maintenance insomnia. INTERVENTIONS: During the acute phase, all participants were exposed to evening bright light (approximately 9:00 p.m. to 11:00 p.m.;>4,000 lux). During the maintenance phase, light treatment was reduced to a twice-weekly schedule, in which the active group received bright light from approximately 9:00 p.m. to 11:00 p.m. and the control group received bright light from 3:00 p.m. to 5:00 p.m. MEASUREMENTS: During each laboratory session, polysomnographic sleep and CBT were measured. RESULTS: Bright light exposure during the acute treatment resulted in an average phase delay in the temperature rhythm (Tmin) of 94 minutes. Sleep quality was not improved. No significant differences between active and control subjects were found during the maintenance phase; in both groups, Tmin gradually reverted to the baseline phase position, and sleep efficiency remained unchanged. CONCLUSIONS: Although a significant phase shift in CBT was achieved during the acute treatment phase, no improvement in sleep quality was observed. Twice-weekly light exposure was not effective in maintaining the circadian phase shift over the subsequent 3 months. Issues of compliance and alternate etiologies for the sleep maintenance insomnia are discussed.

Aged↗
PubMed1998

Health maintenance organization penetration and the practice location choices of new physicians: a study of large metropolitan areas in the United States.

OBJECTIVES: The rapid growth of health maintenance organizations is reshaping the practice opportunities available to physicians. The practice location decisions of new physicians provide a sensitive bellwether of these changes. This study assessed the effect of health maintenance organization penetration on practice location for physicians completing graduate medical education (GME). METHODS: Conditional logit regression analysis was used to determine the effect of health maintenance organization penetration on practice location, controlling for other market characteristics. Subjects were physicians who finished GME between 1989 and 1994 and who located in one of the 98 US metropolitan areas with more than 500,000 population. The outcome measure was the particular metropolitan area chosen by each new physician. RESULTS: Early in the study period, new generalists were significantly more likely to locate in metropolitan areas with high health maintenance organization penetration than in low penetration areas, whereas new specialists' practice location choices were not associated with health maintenance organization penetration. The likelihood of choosing a high penetration relative to a low penetration area declined with time, however, for both generalists and specialists. Consequently, by the end of the study period, health maintenance organization penetration had a weak but significant negative effect on practice location for generalists and a strong negative influence on practice location for specialists. CONCLUSIONS: New generalists who completed graduate medical education between 1989 and 1994 were more likely than new specialists to locate in market areas with high health maintenance organization penetration; however, the proportions of both generalists and specialists who chose high penetration areas decreased during the study period. This finding may reflect reduced practice opportunities in high penetration areas relative to low penetration areas as health maintenance organizations' systems for controlling utilization began to yield results. Alternatively, new physicians may have become more hesitant to accept available positions in high penetration areas.

Adult↗
PubMed2000

Effects of walking training on weight maintenance after a very-low-energy diet in premenopausal obese women: a randomized controlled trial.

BACKGROUND: Maintenance of weight loss is a core problem in the treatment of obesity. Physical activity may improve maintenance and metabolic risk factors associated with obesity. HYPOTHESES: (1) A walking training program of moderate intensity, started after weight reduction by a very-low-energy diet, improves maintenance of weight loss and obesity-related metabolic disorders; and (2) the effect of the training program is related to the prescribed amount of physical activity, ie, a higher amount (energy expenditure) leads to more favorable results. METHODS: The participants were premenopausal women with a mean body mass index of 34.0 kg/m(2). Eighty-two participants were randomized to this study; 74 participated in the follow-up assessment. A 12-week weight reduction by mostly a very-low-energy diet was followed by a 40-week maintenance program randomized in 3 groups: a control group with no increase in habitual exercise and with counseling on diet and relapse prevention; a walk-1 group, with a walking program targeted to expend 4.2 MJ/wk and diet counseling; and a walk-2 group, with a walking program of 8. 4 MJ/wk and diet counseling. Random permuted blocks within strata were used, with weight loss (in 3 classes) as the stratifying factor. After the intervention, the subjects were followed up for 2 years. MAIN OUTCOME MEASURES: Primary outcomes were body weight, fat mass, and waist circumference at the 2-year follow-up. Secondary outcomes were the levels of serum lipoproteins and lipids, plasma glucose, insulin, and blood pressure. RESULTS: The mean weight loss after weight reduction was 13.1 kg. The main outcome variables remained stable during the maintenance program, but increased during the follow-up period. Compared with the end of weight reduction, weight regain at the 2-year follow-up was 3.5 kg less (95% confidence interval, 0.2-6.8) and waist circumference regain 3.8 cm less (95% confidence interval, 0.3-7.3) in the walk-1 group vs controls. The secondary outcomes showed a partial relapse during the maintenance program, and a further regain during the follow-up period. CONCLUSIONS: Inclusion of a walking program of moderate training regimen into a weight maintenance program improved maintenance of losses in weight and waist circumference.

Adult↗
PubMed2005

A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia.

BACKGROUND: A recent randomised controlled trial on Cognitive Stimulation Therapy (CST) identified the need to evaluate its more long-term benefits for people with dementia. This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care. METHOD: Thirty-five people with dementia were included, following on from a seven-week twice-weekly study of CST. The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks. Two control homes did not receive the maintenance intervention. RESULTS: Using repeated measures ANOVAS, there was a continuous, significant improvement in cognitive function (MMSE) for those receiving MCST (CST+maintenance CST sessions) as compared to CST alone or no treatment (p = 0.012). There were no effects on quality of life, behaviour or communication following maintenance sessions. The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions. CONCLUSIONS: The cognitive benefits of CST can be maintained by weekly sessions for around 6 months. A large-scale, multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia.

Aged↗
PubMed1996

Asbestos exposure of building maintenance personnel.

The exposures of building maintenance personnel and occupants to airborne asbestos fibers, and the effects of operations and maintenance programs on those exposures, continue to be an important public health issue. The subject of this investigation was a large metropolitan county with numerous public buildings which routinely conducted air sampling for asbestos. A total of 302 personal air samples in nine task categories collected during maintenance worker activities in proximity to asbestos-containing materials were analyzed; 102 environmental air samples in four task categories were also analyzed. The arithmetic means of the 8-hr time weighted average exposures for personal sampling for each task category were all below the Occupational Safety and Health Administration permissible exposure level of 0.1 fibers (f)/cc > 5 microm. The highest mean 8-hr time weighted average exposure was 0.030 f/cc > 5 microm for ceiling tile replacement. The maximum asbestos concentration during sample collection for environmental samples was 0.027 f/cc > 5 microm. All asbestos-related maintenance work was done within the framework of an Operations and Maintenance Program (OMP) which utilized both personal protective equipment and controls against fiber release/dispersion. Results are presented in association with specific OMP procedures or controls. These results support the effectiveness of using Operations and Maintenance Programs to manage asbestos in buildings without incurring unacceptable risk to maintenance workers performing maintenance tasks.

Air Pollutants↗
PubMed2006

The role of maintenance therapy and novel taxanes in ovarian cancer.

OBJECTIVES: Despite several studies reporting various degrees of success, the role of maintenance chemotherapy in ovarian cancer remains controversial. This article reviews the available data and the controversy surrounding maintenance therapy. In addition, the role of novel taxanes, which may offer an improved therapeutic index and reduced toxicity relative to conventional therapies in this setting, is discussed. METHODS: The available randomized clinical data on extended or maintenance therapy in ovarian cancer are reviewed. RESULTS: Available data indicate that patients with ovarian cancer undergoing taxane maintenance chemotherapy exhibit a reduced recurrence rate and a longer progression-free survival. CONCLUSIONS: While an additional randomized trial is needed to confirm these benefits and establish maintenance therapy as the standard of care, the authors conclude that maintenance therapy is a valuable option that should be discussed with patients until further data are available. The Gynecologic Oncology Group 212 trial is a randomized clinical trial that is designed to answer whether taxane maintenance therapy offers a survival advantage as well as to determine the impact of such a therapeutic regimen on a patient's quality of life. This trial is also designed to address some of the questions regarding the role of a novel taxane in maintenance therapy in ovarian cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Effects of exercise-focused versus weight-focused maintenance programs on the management of obesity.

This study examined the effects of two maintenance programs on exercise participation, energy expenditure, energy consumption, and weight change in 67 obese adults undergoing behavioral weight-loss treatment. Following an initial 6-month treatment phase which produced a mean weight loss of 8.8 kg, participants were assigned randomly to an exercise-focused maintenance program or to a weight-focused maintenance program. Both maintenance programs included 6 months of biweekly group sessions. The exercise-focused program included supervised group walking sessions, individual and group contingencies for exercise completion, and relapse prevention training targeted specifically at the maintenance of physical activity. The weight-focused program contained a general focus on the maintenance of weight-loss through therapist-led group problem-solving of weight-related problems presented by individual participants. At the completion of the maintenance program and at long-term follow-up, there were no significant differences between conditions in exercise participation or energy expenditure. However, during the year following initial treatment, participants in the weight-focused program demonstrated significantly greater reductions in fat consumption and significantly better maintenance of weight losses than subjects in the exercise-focused program.

Adult↗
PubMed2004

Personality pathology and outcome in recurrently depressed women over 2 years of maintenance interpersonal psychotherapy.

BACKGROUND: Empirical data on the impact of personality pathology on acute treatment outcome for depression are mixed, in part because of challenges posed by assessing trait-like personality patterns while patients are in an active mood episode. To our knowledge, no previous study has examined the effect of personality pathology on maintenance treatment outcome. By maintenance treatment we refer to long-term treatment provided to prevent depression recurrence among remitted patients. METHOD: Structured Clinical Interviews for the DSM-III-R Personality Disorders (SCID-II) were obtained on a sample of 125 recurrently depressed women following sustained remission of the acute mood episode and prior to entering maintenance treatment. SCID-II interviews were then repeated following 1 and 2 years of maintenance interpersonal psychotherapy. RESULTS: At the pre-maintenance assessment, 21.6% of the sample met SCID-II personality disorder criteria. Co-morbid personality pathology was related to an earlier age of onset, more previous depressive episodes, and a greater need for adjunctive pharmacotherapy to achieve remission of the acute mood episode. Co-morbid personality pathology predicted both higher rates of depression recurrence and a shorter time to recurrence over the 2-year course of maintenance treatment. Notably, among those patients who remained depression-free, continuous levels of personality pathology steadily declined over the 2-year course of maintenance therapy. CONCLUSIONS: Results highlight the need for early and effective intervention of both episodic mood disorder and inter-episode interpersonal dysfunction inherent to the personality disorders. Future maintenance treatment trials are needed to clarify the relationship between episodic mood disorder and personality function over time.

Adult↗
PubMed2000

Does weight loss maintenance become easier over time?

OBJECTIVE: Studies of health-related behaviors, including weight loss, have shown that risk of relapse decreases over time, although reasons for this relationship are unclear. The purpose of this cross-sectional study was to determine if subjects who have maintained weight losses for varying periods of time report different strategies for weight loss maintenance or differences in the effort and pleasure associated with weight maintenance behaviors. RESEARCH METHODS AND PROCEDURES: Subjects were 758 women and 173 men who had maintained losses of at least 30 lb (mean = 60 lb) for 2 years or longer (mean = 6.8 +/- 7.0 years). Self-administered questionnaires assessed subjects' use of weight maintenance strategies in the past year and their perceptions of the effort, attention, and pleasure associated with weight maintenance. RESULTS: Subjects who had maintained weight losses longer used fewer weight maintenance strategies and reported that less effort was required to diet and maintain weight and that less attention was required to maintain weight. The pleasure derived from exercise, low-fat eating, and maintaining weight was unrelated to duration of weight loss maintenance. DISCUSSION: As duration increases, a shift in the balance between the effort and pleasure of weight maintenance may occur. This shift may increase the likelihood of continued maintenance.

Adult↗
PubMed2000

Maintenance treatment of preterm labor with the oxytocin antagonist atosiban. The Atosiban PTL-098 Study Group.

OBJECTIVES: Patients admitted with an acute episode of preterm labor who respond to early intravenously administered tocolysis remain at risk of having subsequent episodes of preterm labor and preterm delivery. Several pharmacologic agents have been used in an attempt to reduce subsequent episodes of preterm labor, and all are associated with significant side effects. Atosiban, an oxytocin receptor antagonist, is effective in the treatment of an acute episode of preterm labor. This study was designed to compare the efficacy and safety of atosiban with those of placebo maintenance therapy in women with preterm labor who achieved uterine quiescence with intravenous atosiban. STUDY DESIGN: A multicenter, double-blind, placebo-controlled trial was designed for patients in preterm labor who responded to early intravenous treatment with atosiban. Five hundred thirteen patients were randomly assigned to receive maintenance therapy, 252 to receive atosiban, and 251 to receive matching placebo. Maintenance therapy was administered as a continuous subcutaneous infusion, via pump, of 30 microg/min to the end of 36 weeks' gestation. The primary end point was the number of days from the start of maintenance therapy until the first recurrence of labor. A secondary end point was the percentage of patients receiving subsequent intravenous atosiban therapy. RESULTS: The time (median) from the start of maintenance treatment to the first recurrence of labor was 32.6 days with atosiban and 27.6 days with placebo (P =.02). At least one subsequent intravenous atosiban treatment was needed by 61 atosiban patients (23%) and 77 placebo patients (31%). Except for injection site reactions, adverse event profiles of atosiban and placebo were comparable. There were 4 neonatal deaths reported in the atosiban group and 5 in the placebo group after the start of maintenance therapy. Infant outcomes (including birth weight) were comparable between maintenance and treatment groups. CONCLUSIONS: Maintenance therapy with the oxytocin receptor antagonist atosiban can prolong uterine quiescence after successful treatment of an acute episode of preterm labor with atosiban. Treatment was well tolerated.

Adult↗