Search results for: NPWT- negative pressure wound therapy
10011 Sufism as Therapy of Terrorism and Extremism with Special Reference to the Teaching of Khawaja Ghulam Fareed and Bulleh Shah
Authors: Arshad Munir, Naseem Akhtar
Abstract:
The determination of the Sufi is to effort towards unity. His main purpose is to bring humanity, separated as it is into so many different units, closer together in the deeper understanding of life. His mission is to bring about brotherhood among races, nations and faiths and to respect one another's faith, scripture and teacher. Sufi is to confer sympathy on these lives, to impart love, compassion and kindheartedness on all creations. The Sufi message is the resonance of the same Divine message which has always come and will always come to inform humanity. It is the continuation of all the pronounced religions which have come at several times and it is amalgamation of them all, which was the wish of all the prophets. Pakistan, who came into being in the name of Islam unfortunately, have linked with terrorism. It is a disgrace that in contemporary day Pakistan, mullahism and the recent cancer of Talibanisation are gradually eating into what had kept us integral as a society. Terrorism has grown-up to develop a prime safety pressure to the area. The terrorism has deadly caused decrease in overseas and local investment, exports, physical infrastructure, and wealth stock ultimately leading to damage of the socio-economic status of Pakistan. Main reasons are ignorance about the actual teaching of Islam both by Muslim and non-Muslim, exploitation by the religious and political influential, sectarianism and extremism, lack of tolerance and broadmindedness and reaction and retortion by the sufferer. The key treatment and therapy of the abovementioned illnesses exist in the messages of Sufism.Keywords: sufism, love, Pakistan, terrorism
Procedia PDF Downloads 30210010 A Robust System for Foot Arch Type Classification from Static Foot Pressure Distribution Data Using Linear Discriminant Analysis
Authors: R. Periyasamy, Deepak Joshi, Sneh Anand
Abstract:
Foot posture assessment is important to evaluate foot type, causing gait and postural defects in all age groups. Although different methods are used for classification of foot arch type in clinical/research examination, there is no clear approach for selecting the most appropriate measurement system. Therefore, the aim of this study was to develop a system for evaluation of foot type as clinical decision-making aids for diagnosis of flat and normal arch based on the Arch Index (AI) and foot pressure distribution parameter - Power Ratio (PR) data. The accuracy of the system was evaluated for 27 subjects with age ranging from 24 to 65 years. Foot area measurements (hind foot, mid foot, and forefoot) were acquired simultaneously from foot pressure intensity image using portable PedoPowerGraph system and analysis of the image in frequency domain to obtain foot pressure distribution parameter - PR data. From our results, we obtain 100% classification accuracy of normal and flat foot by using the linear discriminant analysis method. We observe there is no misclassification of foot types because of incorporating foot pressure distribution data instead of only arch index (AI). We found that the mid-foot pressure distribution ratio data and arch index (AI) value are well correlated to foot arch type based on visual analysis. Therefore, this paper suggests that the proposed system is accurate and easy to determine foot arch type from arch index (AI), as well as incorporating mid-foot pressure distribution ratio data instead of physical area of contact. Hence, such computational tool based system can help the clinicians for assessment of foot structure and cross-check their diagnosis of flat foot from mid-foot pressure distribution.Keywords: arch index, computational tool, static foot pressure intensity image, foot pressure distribution, linear discriminant analysis
Procedia PDF Downloads 50010009 Narrative Family Therapy and the Treatment of Perinatal Mood and Anxiety Disorders
Authors: Jamie E. Banker
Abstract:
For many families, pregnancy and the postpartum time are filled with both anticipation and change. For some pregnant or postpartum women, this time is marked by the onset of a mood or anxiety disorder. Experiencing a mood or anxiety disorders during this time of life differs from depression or anxiety at other times of life. Not only because of the physical changes occurring in the mother’s body but also the mental and physical preparation necessary to redefine family roles, responsibilities, and develop new identities in the life transition. The presence of a mood or anxiety disorder can influence the way in which a mother defines herself and can complicate her understanding of her abilities and competencies as a mother. The complexity of experiencing a mood or anxiety disorder in the midst of these changes necessitates specific treatment interventions to match both the symptomatology and psychological adjustments. This study explores the use of narrative family therapy techniques when treating a mother who is experiencing postpartum depression. Externalization is a common technique used in narrative family therapy and can help client’s separate their identity from the problems they are experiencing. This is crucial to a new mom who is in the middle of defining her identity during her transition to parenthood. The goal of this study is to examine how the use of externalization techniques help postpartum women separate their mood and anxiety symptoms from their identity as a mother. An exploratory case study design was conducted in a single setting, private practice therapy office, and explored how a narrative family therapy approach can be used to treat perinatal mood and anxiety disorders. The therapy sessions were audio recorded and transcribed. Constructivism and narrative theory are used as theoretical frameworks and data from the therapy sessions, and a follow-up survey was triangulated and analyzed. During the course of the treatment, the participant reports using the new externalizing labels for her symptoms. Within one month of treatment, the participant reports that she could stop herself from thinking the harmful thoughts faster, and within three months, the harmful thoughts went away. The main themes in this study were building courage and less self-blame. This case highlights the role narrative family therapy can play in the treatment of perinatal mood and anxiety disorders and the importance of separating a women’s mood from her identity as a mother. This conceptual framework was beneficial to the postpartum mother when treating perinatal mood and anxiety disorder symptoms.Keywords: externalizing techniques, narrative family therapy, perinatal mood and anxiety disorders, postpartum depression
Procedia PDF Downloads 27510008 An Investigation of the Therapeutic Effects of Indian Classical Music (Raga Bhairavi) on Mood and Physiological Parameters of Scholars
Authors: Kalpana Singh, Nikita Katiyar
Abstract:
This research investigates the impact of Raga Bhairavi, a prominent musical scale in Indian classical music, on the mood and basic physiological parameters of research scholars at the University of Lucknow - India. The study focuses on the potential therapeutic effects of listening to Raga Bhairavi during morning hours. A controlled experimental design is employed, utilizing self-reporting tools for mood assessment and monitoring physiological indicators such as heart rate, oxygen saturation levels, body temperature and blood pressure. The hypothesis posits that exposure to Raga Bhairavi will lead to positive mood modulation and a reduction in physiological stress markers among research scholars. Data collection involves pre and post-exposure measurements, providing insights into the immediate and cumulative effects of the musical intervention. The study aims to contribute valuable information to the growing field of music therapy, offering a potential avenue for enhancing the well-being and productivity of individuals engaged in intense cognitive activities. Results may have implications for the integration of music-based interventions in academic and research environments, fostering a conducive atmosphere for intellectual pursuits.Keywords: bio-musicology, classical music, mood assessment, music therapy, physiology, Raga Bhairavi
Procedia PDF Downloads 5410007 Increasing the Forecasting Fidelity of Current Collection System Operating Capability by Means of Contact Pressure Simulation Modelling
Authors: Anton Golubkov, Gleb Ermachkov, Aleksandr Smerdin, Oleg Sidorov, Victor Philippov
Abstract:
Current collection quality is one of the limiting factors when increasing trains movement speed in the rail sector. With the movement speed growth, the impact forces on the current collector from the rolling stock and the aerodynamic influence increase, which leads to the spread in the contact pressure values, separation of the current collector head from the contact wire, contact arcing and excessive wear of the contact elements. The upcoming trend in resolving this issue is the use of the automatic control systems providing stabilization of the contact pressure value. The present paper considers the features of the contemporary automatic control systems of the current collector’s pressure; their major disadvantages have been stated. A scheme of current collector pressure automatic control has been proposed, distinguished by a proactive influence on undesirable effects. A mathematical model of contact strips wearing has been presented, obtained in accordance with the provisions of the central composition rotatable design program. The analysis of the obtained dependencies has been carried out. The procedures for determining the optimal current collector pressure on the contact wire and the pressure control principle in the pneumatic drive have been described.Keywords: contact strip, current collector, high-speed running, program control, wear
Procedia PDF Downloads 14510006 Support of Syrian Refugees: The Roles of Descriptive and Injunctive Norms, Perception of Threat, and Negative Emotions
Authors: Senay Yitmen
Abstract:
This research investigated individual’s support and helping intentions towards Syrian refugees in Turkey. This is examined in relation to perceived threat and negative emotions, and also to the perceptions of whether one’s intimate social network (family and friends) considers Syrians a threat (descriptive network norm) and whether this network morally supports Syrian refugees (injunctive norms). A questionnaire study was conducted among Turkish participants (n= 565) and the results showed that perception of threat was associated with negative emotions which, in turn, were related to less support of Syrian refugees. Additionally, descriptive norms moderated the relationship between perceived threat and negative emotions towards Syrian refugees. Furthermore, injunctive norms moderated the relationship between negative emotions and support to Syrian refugees. Specifically, the findings indicate that perceived threat is associated with less support of Syrian refugees through negative emotions when descriptive norms are weak and injunctive norms are strong. Injunctive norms appear to trigger a dilemma over the decision to conform or not to conform: when one has negative emotions as a result of perceived threat, it becomes more difficult to conform to the moral obligation of injunctive norms which is associated with less support of Syrian refugees. Hence, these findings demonstrate that both descriptive and injunctive norms are important and play different roles in individual’s support of Syrian refugees.Keywords: descriptive norms, emotions, injunctive norms, the perception of threat
Procedia PDF Downloads 19110005 Blood Pressure Level, Targeted Blood Pressure Control Rate, and Factors Related to Blood Pressure Control in Post-Acute Ischemic Stroke Patients
Authors: Nannapus Saramad, Rewwadee Petsirasan, Jom Suwanno
Abstract:
Background: This retrospective study design was to describe average blood pressure, blood pressure level, target blood pressure control rate post-stroke BP control in the year following discharge from Sichon hospital, Sichon District, Nakhon Si Thammarat province. The secondary data analysis was employed from the patient’s health records with patient or caregiver interview. A total of 232 eligible post-acute ischemic strokes in the year following discharge (2017-2018) were recruited. Methods: Data analyses were applied to identify the relationship values of single variables were determined through univariate analyses: The Chi-square test, Fisher exact test, the variables found to have a p-value < 0.2 were analyzed by the binary logistic regression Results: Most of the patients in this study were men 61.6%, an average age of 65.4 ± 14.8 years. Systolic blood pressure levels were in the grade 1-2 hypertension and diastolic pressure at optimal and normal at all times during the initial treatment through the present. The results revealed 25% among the groups under the age of 60 achieved BP control; 36.3% for older than 60 years group; and 27.9% for diabetic group. The multivariate analysis revealed the final relationship of four significant variables: 1) receiving calcium-channel blocker (p =.027); 2) medication adherence of antihypertensive (p = .024) 3) medication adherence of antiplatelet ( p = .020); and 4) medication behavior ( p = . 010) . Conclusion: The medical nurse and health care provider should promote their adherence to behavior to improve their blood pressure control.Keywords: acute ischemic stroke, target blood pressure control, medication adherence, recurrence stroke
Procedia PDF Downloads 12210004 MONDO Neutron Tracker Characterisation by Means of Proton Therapeutical Beams and MonteCarlo Simulation Studies
Authors: G. Traini, V. Giacometti, R. Mirabelli, V. Patera, D. Pinci, A. Sarti, A. Sciubba, M. Marafini
Abstract:
The MONDO (MOnitor for Neutron Dose in hadrOntherapy) project aims a precise characterisation of the secondary fast and ultrafast neutrons produced in particle therapy treatments. The detector is composed of a matrix of scintillating fibres (250 um) readout by CMOS Digital-SPAD based sensors. Recoil protons from n-p elastic scattering are detected and used to track neutrons. A prototype was tested with proton beams (Trento Proton Therapy Centre): efficiency, light yield, and track-reconstruction capability were studied. The results of a MonteCarlo FLUKA simulation used to evaluated double scattering efficiency and expected backgrounds will be presented.Keywords: secondary neutrons, particle therapy, tracking, elastic scattering
Procedia PDF Downloads 26810003 Simultaneous Measurement of Pressure and Temperature Profile of Lubricating Oil-Film along Orthogonally Displaced Non-Circular Journal Bearing: An Experimental Study
Authors: Amit Singla, Amit Chauhan
Abstract:
The non-circular journal bearings provide better thermal stability and lesser oil-film temperature rise as compared to circular journal bearings. Experimentation on simultaneous measurement of pressure and temperature of lubricated oil-film along the profile of the bearing will help the designer to design journal bearings. In this paper, pressure and temperature of oil-film along orthogonally displaced non-circular journal bearing have been measured on a designed journal bearing test rig. The orthogonal non-circular journal bearing has been fabricated by displacing two circular halves away from the centers in the orthogonal direction. The data acquisition for oil film pressure and temperature has been carried out at journal speed=3000 rpm and by increasing the static radial load from 500 N to 2000 N in steps of 500 N using three different grades of oil (ISOVG 32, 68, and 150) named as oil-1, oil-2, and oil-3 respectively. The results show that the oil-film pressure and temperature increases with increase in radial load and change of lubricating oil towards increasing viscosity. Further, two lobes in the pressure and temperature profiles have been obtained which accounts for better thermal stability as it reduces cavitation zone inside the bearing.Keywords: cavitation, non-circular journal bearing, orthogonally displaced, thermal stability
Procedia PDF Downloads 35410002 Optical Coherence Tomography in Differentiation of Acute and Non-Healing Wounds
Authors: Ananya Barui, Provas Banerjee, Jyotirmoy Chatterjee
Abstract:
Application of optical technology in medicine and biology has a long track-record. In this endeavor, OCT is able to attract both engineers and biologists to work together in the field of photonics for establishing a striking non-invasive imaging technology. In contrast to other in vivo imaging modalities like Raman imaging, confocal imaging, two-photon microscopy etc. which can perform in vivo imaging upto 100-200 micron depth due to limitation in numerical aperture or scattering, however, OCT can achieve high-resolution imaging upto few millimeters of tissue structures depending on their refractive index in different anatomical location. This tomographic system depends on interference of two light waves in an interferometer to produce a depth profile of specimen. In wound healing, frequent collection of biopsies for follow-up of repair process could be avoided by such imaging technique. Real time skin OCT (the optical biopsy) has efficacy in deeper and faster illumination of cutaneou tissue to acquire high resolution cross sectional images of their internal micro-structure. Swept Source-OCT (SS-OCT), a novel imaging technique, can generate high-speed depth profile (~ 2 mm) of wound at a sweeping rate of laser with micron level resolution and optimum coherent length of 5-6 mm. Normally multi-layered skin tissue depicts different optical properties along with variation in thickness, refractive index and composition (i.e. keratine layer, water, fat etc.) according to their anatomical location. For instance, stratum corneum, the upper-most and relatively dehydrated layer of epidermis reflects more light and produces more lucid and a sharp demarcation line with rest of the hydrated epidermal region. During wound healing or regeneration, optical properties of cutaneous tissue continuously altered with maturation of wound bed. More mature and less hydrated tissue component reflects more light and becomes visible as a brighter area in comparison to immature region which content higher amount water or fat that depicts as a darker area in OCT image. Non-healing wound possess prolonged inflammation and inhibits nascent proliferative stage. Accumulation of necrotic tissues also prevents the repair of non-healing wounds. Due to high resolution and potentiality to reflect the compositional aspects of tissues in terms of their optical properties, this tomographic method may facilitate in differentiating non-healing and acute wounds in addition to clinical observations. Non-invasive OCT offers better insight regarding specific biological status of tissue in health and pathological conditions, OCT images could be associated with histo-pathological ‘gold standard’. This correlated SS-OCT and microscopic evaluation of the wound edges can provide information regarding progressive healing and maturation of the epithelial components. In the context of searching analogy between two different imaging modalities, their relative performances in imaging of healing bed were estimated for probing an alternative approach. Present study validated utility of SS-OCT in revealing micro-anatomic structure in the healing bed with newer information. Exploring precise correspondence of OCT images features with histo-chemical findings related to epithelial integrity of the regenerated tissue could have great implication. It could establish the ‘optical biopsy’ as a potent non-invasive diagnostic tool for cutaneous pathology.Keywords: histo-pathology, non invasive imaging, OCT, wound healing
Procedia PDF Downloads 27910001 I Can’t Escape the Scars, Even If I Do Get Better”: A Discourse Analysis of Adolescent Talk About Their Self-Harm During Cognitive-Behavioural Therapy Sessions for Major Depressive Disorder
Authors: Anna Kristen
Abstract:
There has been a pronounced increase in societal discourses around adolescent self-harm, yet there is a paucity of literature examining adolescent talk about self-harm that accounts for the sociocultural context. The objective of this study was to explore how adolescents with Depression talk about their self-harm engagement in consideration of both socio-cultural discourses and the therapy context during Cognitive-Behavioural Therapy (CBT) sessions. Utilizing a sample from the Improving Mood with Psychoanalytic and Cognitive Therapies study, discourse analysis was carried out on audio-recorded CBT sessions. The study established three groupings of results: (a) adolescent positioning as stuck in self-harm engagement; (b) adolescent positioning as ambivalent in the talk about ceasing self-harm; and (c) adolescent use of stigma discourses in self-harm talk & constructions of self-harm scars. These findings indicate that clinician awareness of adolescent use of language and discourse may inform interventions beyond Manualized CBT strategies. These findings are highly relevant in light of research that demonstrates CBT treatment for adolescent depression does not effectively address concurring self-harm and given that self-harm is the most significant risk factor predictive of subsequent suicidal behaviours.Keywords: adolescence, cognitive-behavioral therapy, discourse, self-harm, stigma
Procedia PDF Downloads 24910000 The Use of Vasopressin in the Management of Severe Traumatic Brain Injury: A Narrative Review
Authors: Nicole Selvi Hill, Archchana Radhakrishnan
Abstract:
Introduction: Traumatic brain injury (TBI) is a leading cause of mortality among trauma patients. In the management of TBI, the main principle is avoiding cerebral ischemia, as this is a strong determiner of neurological outcomes. The use of vasoactive drugs, such as vasopressin, has an important role in maintaining cerebral perfusion pressure to prevent secondary brain injury. Current guidelines do not suggest a preferred vasoactive drug to administer in the management of TBI, and there is a paucity of information on the therapeutic potential of vasopressin following TBI. Vasopressin is also an endogenous anti-diuretic hormone (AVP), and pathways mediated by AVP play a large role in the underlying pathological processes of TBI. This creates an overlap of discussion regarding the therapeutic potential of vasopressin following TBI. Currently, its popularity lies in vasodilatory and cardiogenic shock in the intensive care setting, with increasing support for its use in haemorrhagic and septic shock. Methodology: This is a review article based on a literature review. An electronic search was conducted via PubMed, Cochrane, EMBASE, and Google Scholar. The aim was to identify clinical studies looking at the therapeutic administration of vasopressin in severe traumatic brain injury. The primary aim was to look at the neurological outcome of patients. The secondary aim was to look at surrogate markers of cerebral perfusion measurements, such as cerebral perfusion pressure, cerebral oxygenation, and cerebral blood flow. Results: Eight papers were included in the final number. Three were animal studies; five were human studies, comprised of three case reports, one retrospective review of data, and one randomised control trial. All animal studies demonstrated the benefits of vasopressors in TBI management. One animal study showed the superiority of vasopressin in reducing intracranial pressure and increasing cerebral oxygenation over a catecholaminergic vasopressor, phenylephrine. All three human case reports were supportive of vasopressin as a rescue therapy in catecholaminergic-resistant hypotension. The retrospective review found vasopressin did not increase cerebral oedema in TBI patients compared to catecholaminergic vasopressors; and demonstrated a significant reduction in the requirements of hyperosmolar therapy in patients that received vasopressin. The randomised control trial results showed no significant differences in primary and secondary outcomes between TBI patients receiving vasopressin versus those receiving catecholaminergic vasopressors. Apart from the randomised control trial, the studies included are of low-level evidence. Conclusion: Studies favour vasopressin within certain parameters of cerebral function compared to control groups. However, the neurological outcomes of patient groups are not known, and animal study results are difficult to extrapolate to humans. It cannot be said with certainty whether vasopressin’s benefits stand above usage of other vasoactive drugs due to the weaknesses of the evidence. Further randomised control trials, which are larger, standardised, and rigorous, are required to improve knowledge in this field.Keywords: catecholamines, cerebral perfusion pressure, traumatic brain injury, vasopressin, vasopressors
Procedia PDF Downloads 679999 Identifying the Source of Stress and Coping Strategies of Undergraduate Occupational Therapy Students' of BHPI in Bangladesh
Authors: Md. Toufiq Hasan
Abstract:
This research set out to explore the source of stress and coping strategies of undergraduate Occupational Therapy students’ of Bangladesh Health Professions Institute (BHPI) in Bangladesh. For that reason, a quantitative and prospective type survey has been conducted by the researcher with 27 student participants of BHPI Occupational Therapy department whose stress scores were ≥40 according to Zung’s self-rating depression scale. Data was collected by using Bengali and English joined questionnaire of Inventory of College Students’ Recent Life Experience and Ways of Coping Scale. The researcher followed ‘Comprehensive sampling’ procedure to study the entire group of population. From the in-depth analysis to data found some source of stress and coping strategies of the students’. Stress was found significantly more in 2nd year students rather than other years. Female students were more vulnerable for stress rather than male. The age ranges 18-20 years of students are more vulnerable for stress. The main sources of stresses are found that, a lot of responsibilities and too many things to do at once and not enough time to meet their obligation or duties. The important coping strategies are found that, they criticized or lectured their selves, tried not to burn their bridges, but leave things open somewhat and inspired to do something creative. Findings of the study highlighted the need for teachers-students interactive relationship for better academic performance. The study also discloses some important recommendations for the students and teachers. At last the findings of the study will help the Occupational Therapy students and teachers of BHPI.Keywords: BHPI undergraduate occupational therapy students, stress, source of stress, coping strategies
Procedia PDF Downloads 3309998 Influence of Stress Relaxation and Hysteresis Effect for Pressure Garment Design
Authors: Chia-Wen Yeh, Ting-Sheng Lin, Chih-Han Chang
Abstract:
Pressure garment has been used to prevent and treat the hypertrophic scars following serious burns since 1970s. The use of pressure garment is believed to hasten the maturation process and decrease the highness of scars. Pressure garment is custom made by reducing circumferential measurement of the patient by 10%~20%, called Reduction Factor. However the exact reducing value used depends on the subjective judgment of the therapist and the feeling of patients throughout the try and error process. The Laplace Law can be applied to calculate the pressure from the dimension of the pressure garment by the circumferential measurements of the patients and the tension profile of the fabrics. The tension profile currently obtained neglects the stress relaxation and hysteresis effect within most elastic fabrics. The purpose of this study was to investigate the influence of the tension attenuation, from stress relaxation and hysteresis effect of the fabrics. Samples of pressure garment were obtained from Sunshine Foundation Organization, a nonprofit organization for burn patients in Taiwan. The wall tension profile of pressure garments were measured on a material testing system. Specimens were extended to 10% of the original length, held for 1 hour for the influence of the stress relaxation effect to take place. Then, specimens were extended to 15% of the original length for 10 seconds, then reduced to 10% to simulate donning movement for the influence of the hysteresis effect to take place. The load history was recorded. The stress relaxation effect is obvious from the load curves. The wall tension is decreased by 8.5%~10% after 60mins of holding. The hysteresis effect is obvious from the load curves. The wall tension is increased slightly, then decreased by 1.5%~2.5% and lower than stress relaxation results after 60mins of holding. The wall tension attenuation of the fabric exists due to stress relaxation and hysteresis effect. The influence of hysteresis is more than stress relaxation. These effect should be considered in order to design and evaluate the pressure of pressure garment more accurately.Keywords: hypertrophic scars, hysteresis, pressure garment, stress relaxation
Procedia PDF Downloads 5129997 Prevalence of Rituximab Efficacy Over Immunosuppressants in Therapy of Systemic Sclerosis
Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva
Abstract:
Abstract Objectives. Rituximab (RTX) shown a positive effect in the treatment of systemic sclerosis (SSc). But there is still not enough data on comparing the effectiveness of RTX with immunosuppressants (IS). The aim of our study was to compare changes of lung function and skin score in SSc between two groups of patients (pts) - on RXT therapy (prescribed after ineffectiveness of previous therapy with IS) and on therapy with IS only. Methods. This study included 103 pts received RTX as an addition to previous therapy (group 1) and 65 pts received therapy with IS and prednisolone (group 2). The mean follow-up period was 12.6±10.7months. In group 1 the mean age was 47±12.9 years, female – 88 pts (84%), the diffuse cutaneous subset of the disease had 55 pts (53%). The mean disease duration was 6.2±5.5 years. 82% pts had interstitial lung disease (ILD) and 92% were positive for ANA, 67% of them were positive for antitopoisomerase-1. All pts received prednisolone at a dose of 11.3±4.5 mg/day, IS at inclusion received 47% of them. The cumulative mean dose of RTX was 1.7±0.6 g. In group 2 the mean age was 50.8±13.8 years, female-53 pts (82%), the diffuse cutaneous subset of the disease had 44 pts (68%). The mean disease duration was 8.8±7.7 years. 81% pts had ILD and 88% were positive for ANA, 58% of them were positive for antitopoisomerase-1. All pts received prednisolone at a dose of 8.69±4.28 mg/day, IS received 57% of them. Cyclophosphamide (CP) received 45% of pts. The cumulative mean dose of CP was 10.2±15.1g. D-penicillamine received 30% of pts. Other pts was on mycophenolate mofetil or methotrexate therapy in single cases. The pts of the compared groups did not differ in the main demographic and clinical parameters. The results are presented as delta (Δ) - difference between the baseline parameter and follow up point. Results. In group 1 there was an improvement of all outcome parameters: increased of forced vital capacity, % predicted - ΔFVC=4% (p=0.0004); Diffusing capacity for carbon monoxide, % predicted remained stable (ΔDLCO=0.1%); improvement of the Rodnan skin score-ΔmRss=3.4 (p=0.001); decrease of Activity index (EScSG-AI) - ΔActivity index=1.7 (p=0.001). In group 2 the changes was insignificant: ΔFVC=-2.3%, ΔmRss=0.87, ΔActivity index=0.3. But there was a significant decrease of DLCO: ΔDLCO=-5.1% (p=0.001). Conclusion. The results of our study confirm the data on the positive effect of RTX in complex therapy in pts with SSc (decrease of skin induration, increase of FVC, stabilization of DLCO). Meantime, pts on IS and prednisolone therapy shown the worsening of lung function and insignificant changes of other clinical parameters. RTX could be considered as a more effective option in complex treatment of SSc in comparison with IS therapyKeywords: immunosuppressants, interstitial lung disease, systemic sclerosis, rituximab
Procedia PDF Downloads 849996 Development and in vitro Evaluation of Polymer-Drug Conjugates Containing Potentiating Agents for Combination Therapy
Authors: Blessing A. Aderibigbe
Abstract:
Combination therapy is a treatment approach that is used to prevent the emergence of drug resistance. This approach is used for the treatment of many chronic and infectious diseases. Potentiating agents are currently explored in combination therapy, resulting in excellent therapeutic outcomes. Breast cancer and malaria are two chronic conditions responsible globally for high death rates. In this research, a class of polymer-drug conjugates containing potentiating agents with either antimalarial or anticancer drugs were prepared by Michael Addition Polymerization reaction and ring-opening polymerization reaction. Conjugation of potentiating agents with bioactive compounds into the polymers resulted in conjugates with good water solubility, highly selective and non-toxic. In vitro cytotoxicity and in vitro antiplasmodial evaluation on the conjugates revealed that the conjugates were more effective when compared to the free drugs. The drug release studies further showed that the release profile of the drugs from the conjugates was sustained. The findings revealed the potential of polymer-drug conjugates to overcome drug toxicity and drug resistance, which is common with the currently used antimalarial and anticancer drugs.Keywords: anticancer, antimalarials, combination therapy, polymer-drug conjugates
Procedia PDF Downloads 1349995 A Soil Stabilization Technique on Apa-Hotamiş Conveyance Channel
Authors: Ali Sinan Soğancı
Abstract:
Apa-Hotamış conveyance channel is located within in the boundaries of Konya Regional Directorate of Water Works. This channel transfers the water to the fount of Apa Dam with 17 km length of Blue Channel. Then the water is transmitted with Apa- Hotamış conveyance channel to Hotamış Water Storage. In some places along the Apa-Hotamış conveyance canal which will be constructed by Directorate of Water Works of Konya, some swelling soils have been seen. The samples taken from these places have 35-95 kPa swelling pressure. To prevent the swelling pressure arising from the penetration of water to the concrete channel, it was proposed to make 10 cm concrete coating by spreading the geomembrane and geotextile between the soil and concrete. In this way, the pressure (35-95 kPa) caused by the swelling and cracking of concrete failure will be blocked.Keywords: conveyance channel, swelling pressure, geomembrane, geotextile, concrete
Procedia PDF Downloads 4139994 Simulation and Analysis of Different Parameters in Hydraulic Circuit Due to Leakage
Abstract:
Leakage is the main gradual failure in the fluid power system, which is usually caused by the impurity in the oil and wear of matching surfaces between parts and lead to the change of the gap value. When leakage occurs in the system, the oil will flow from the high pressure chamber into the low pressure chamber through the gap, causing the reduction of system flow as well as the loss of system pressure, resulting in the decreasing of system efficiency. In the fluid power system, internal leakage may occur in various components such as gear pump, reversing valve and hydraulic cylinder, and affect the system work performance. Therefore, component leakage in the fluid power system is selected as the study to characterize the leakage and the effect of leakage on the system. Effect of leakage on system pressure and cylinder displacement can be obtained using pressure sensors and the displacement sensor. The leakage can be varied by changing the orifice using a flow control valve. Hydraulic circuit for leakage will be developed in Matlab/Simulink environment and simulations will be done by changing different parameters.Keywords: leakage causes, effect, analysis, MATLAB simulation, hydraulic circuit
Procedia PDF Downloads 4019993 Comparative Efficacy of Prolene and Polyester Mesh for the Repair of Abdominal Wall Defect in Pigeons (Columba livia)
Authors: Muhammad Naveed Ali, Hamad Bin Rashid, Muhammad Arif Khan, Abdul Basit, Hafiz Muhammad Arshad
Abstract:
Abdominal defects are very common in pigeons. A new technique is known as intraabdominal mesh transplant that give better protection for herniorrhaphy. The aim of this study was to determine the performance of hernia mesh. In this study, an efficacy of two synthetic hernia mesh implants viz. conventional Prolene and a lightweight mesh monofilament polyester were assessed for the abdominal wall repair in pigeons. Twenty four healthy pigeons were selected and randomly distributed into three groups, A, B and C (n=8). In all groups, experimental laparotomy was performed; thereafter, abdominal muscles and peritoneum were sutured together, while, a 2 x 2 cm defect was created in the abdominal muscles. For onlay hernioplasty, the hernia mesh (Prolene mesh: group A; Polyester mesh: group B) was implanted over the external oblique muscles of the abdomen. In group C (control), the mesh was not implanted; instead, the laparotomy incision was closed after a herniorrhaphy. Post-operative pain wound healing, adhesion formation, histopathological findings and formation of hematoma, abscess and seroma were assessed as short-term complications. Post-operatively, pain at surgical site was significantly less (P < 0.001) in group B (Polyester mesh); wound healing was also significantly better and rapid in group B (P < 0.05) than in group A (Prolene mesh). Group B (Polyester mesh) also depicted less than 25% adhesions when assessed on the basis of a Quantitative Modified Diamond scale; a Qualitative Adhesion Tenacity scale also depicted either no adhesions or flimsy adhesions (n=2) in group B (Polyester mesh), in contrast to group A (Prolene), which manifested greater adhesion formation and presence of dense adhesions requiring blunt dissection. There were observed hematoma, seroma and abscess formations in birds treated by Prolene mesh only. Conclusively, the polyester mesh proved superior to the Prolene mesh regarding lesser adhesion, better in wound healing, and no short-term follow-up complications.Keywords: adhesion, mesh, polyester, prolene
Procedia PDF Downloads 2489992 Variation of Airfoil Pressure Profile Due to Confined Air Streams: Application in Gas-Oil Separators
Authors: Amir Hossein Haji, Nabeel Al-Rawahi, Gholamreza Vakili-Nezhaad
Abstract:
An innovative design has been examined for a gas-oil separator based on pressure reduction over an airfoil surface. The primary motivations are to shorten the release trajectory of the bubbles by minimizing the thickness of the oil layer as well as improving uniform pressure reduction zones. Restricted airflow over an airfoil is investigated for its effect on the pressure drop enhancement and the maximum attainable attack angle prior to the stall condition. Aerodynamic separation is delayed based on numerical simulation of Wortmann FX 63137 Airfoil in a confined domain using FLUENT 6.3.26. The proposed set up results in higher pressure drop compared with the free stream case. With the aim of optimum power consumption we have pursued further restriction to an air jet case over the airfoil. Then, a curved strip model is suggested for the air jet which can be applied as an analysis/design tool for the best performance conditions. Pressure reduction is shown to be inversely proportional to the curvature of the upper airfoil profile. This reduction occurs within the tracking zones where the air jet is effectively attached to the airfoil surface. The zero slope condition is suggested to estimate the onset of these zones after which the minimum curvature should be searched. The corresponding zero slope curvature is applied for estimation of the maximum pressure drop which shows satisfactory agreement with the simulation results.Keywords: airfoil, air jet, curved fluid flow, gas-oil separator
Procedia PDF Downloads 4749991 Polishing Machine Based on High-Pressure Water Jet
Authors: Mohammad A. Khasawneh
Abstract:
The design of high pressure water jet based polishing equipment and its fabrication conducted in this study is reported herein, together with some preliminary test results for assessing its applicability for HMA surface polishing. This study also provides preliminary findings concerning the test variables, such as the rotational speed, the water jet pressure, the abrasive agent used, and the impact angel that were experimentally investigated in this study. The preliminary findings based on four trial tests (two on large slab specimens and two on small size gyratory compacted specimens), however, indicate that both friction and texture values tend to increase with the polishing durations for two combinations of pressure and rotation speed of the rotary deck. It seems that the more polishing action the specimen is subjected to; the aggregate edges are created such that the surface texture values are increased with the accompanied increase in friction values. It may be of interest (but which is outside the scope of this study) to investigate if the similar trend exist for HMA prepared with aggregate source that is sand and gravel.Keywords: high-pressure, water jet, friction, texture, polishing, statistical analysis
Procedia PDF Downloads 4879990 Kinetic Study of Physical Quality Changes on Jumbo Squid (Dosidicus gigas) Slices during Application High-Pressure Impregnation
Authors: Mario Perez-Won, Roberto Lemus-Mondaca, Fernanda Marin, Constanza Olivares
Abstract:
This study presents the simultaneous application of high hydrostatic pressure (HHP) and osmotic dehydration of jumbo squid (Dosidicus gigas) slice. Diffusion coefficients for both components water and solids were improved by the process pressure, being influenced by pressure level. The working conditions were different pressures such as 100, 250, 400 MPa and pressure atmospheric (0.1 MPa) for time intervals from 30 to 300 seconds and a 15% NaCl concentration. The mathematical expressions used for mass transfer simulations both water and salt were those corresponding to Newton, Henderson and Pabis, Page and Weibull models, where the Weibull and Henderson-Pabis models presented the best fitted to the water and salt experimental data, respectively. The values for water diffusivity coefficients varied from 1.62 to 8.10x10⁻⁹ m²/s whereas that for salt varied among 14.18 to 36.07x10⁻⁹ m²/s for selected conditions. Finally, as to quality parameters studied under the range of experimental conditions studied, the treatment at 250 MPa yielded on the samples a minimum hardness, whereas springiness, cohesiveness and chewiness at 100, 250 and 400 MPa treatments presented statistical differences regarding to unpressurized samples. The colour parameters L* (lightness) increased, however, but b* (yellowish) and a* (reddish) parameters decreased when increasing pressure level. This way, samples presented a brighter aspect and a mildly cooked appearance. The results presented in this study can support the enormous potential of hydrostatic pressure application as a technique important for compounds impregnation under high pressure.Keywords: colour, diffusivity, high pressure, jumbo squid, modelling, texture
Procedia PDF Downloads 3469989 Assessment of Barriers to the Clinical Adoption of Cell-Based Therapeutics
Authors: David Pettitt, Benjamin Davies, Georg Holländer, David Brindley
Abstract:
Cellular based therapies, whose origins can be traced from the intertwined concepts of tissue engineering and regenerative medicine, have the potential to transform the current medical landscape and offer an approach to managing what were once considered untreatable diseases. However, despite a large increase in basic science activity in the cell therapy arena alongside a growing portfolio of cell therapy trials, the number of industry products available for widespread clinical use correlates poorly with such a magnitude of activity, with the number of cell-based therapeutics in mainstream use remaining comparatively low. This research serves to quantitatively assess the barriers to the clinical adoption of cell-based therapeutics through identification of unique barriers, specific challenges and opportunities facing the development and adoption of such therapies.Keywords: cell therapy, clinical adoption, commercialization, translation
Procedia PDF Downloads 4019988 Optimization of Fin Type and Fin per Inch on Heat Transfer and Pressure Drop of an Air Cooler
Authors: A. Falavand Jozaei, A. Ghafouri
Abstract:
Operation enhancement in an air cooler (heat exchanger) depends on the rate of heat transfer, and pressure drop. In this paper, for a given heat duty, study of the effects of FPI (fin per inch) and fin type (circular and hexagonal fins) on two parameters mentioned above is considered in an air cooler in Iran, Arvand petrochemical. A program in EES (Engineering Equations Solver) software moreover, Aspen B-JAC and HTFS+ software are used for this purpose to solve governing equations. At first the simulated results obtained from this program is compared to the experimental data for two cases of FPI. The effects of FPI from 3 to 15 over heat transfer (Q) to pressure drop ratio (Q/Δp ratio). This ratio is one of the main parameters in design, rating, and simulation heat exchangers. The results show that heat transfer (Q) and pressure drop increase with increasing FPI (fin per inch) steadily, and the Q/Δp ratio increases to FPI = 12 (for circular fins about 47% and for hexagonal fins about 69%) and then decreased gradually to FPI = 15 (for circular fins about 5% and for hexagonal fins about 8%), and Q/Δp ratio is maximum at FPI = 12. The FPI value selection between 8 and 12 obtained as a result to optimum heat transfer to pressure drop ratio. Also by contrast, between circular and hexagonal fins results, the Q/Δp ratio of hexagonal fins more than Q/Δp ratio of circular fins for FPI between 8 and 12 (optimum FPI).Keywords: air cooler, circular and hexagonal fins, fin per inch, heat transfer and pressure drop
Procedia PDF Downloads 4549987 Active Abdominal Compression Device for Treatment of Orthostatic Hypotension
Authors: Vishnu Emani, Andreas Escher, Ellen Roche
Abstract:
Background: Orthostatic hypotension (OH) is an autonomic disorder marked by a sudden drop in blood pressure upon standing resulting from autonomic dysfunction. OH is especially prevalent in elderly populations, affecting more than 30% of Americans over the age of 70. OH is one of the most significant risk factors for accidental falls in elderly populations, making it a crucial focus for medical and device therapies. Pharmacologic therapy with midodrine and fludrocortisone may alleviate hypotension but have significant adverse side effects. Abdominal passive compression devices (binders) are more effective than lower extremity compression stockings at mitigating postural hypotension, by improving venous return to the heart. However, abdominal binders are difficult to don and uncomfortable to wear, leading to poor compliance. A disadvantage of passive compression devices is their inability to selectively compress during the crucial moment of standing. We have recently developed an active compression device that applies external pressure on the abdomen during the transition from a prone to a supine position and conducted initial prototype testing. Methods: An active abdominal compression device was developed utilizing a simple, servo-driven straptightening mechanism to supply tension onto foam fabric, which applies pressure to the abdomen. Healthy volunteers (n=5) were utilized for prototype testing and were subjected to three conditions: no compression, passive compression (i.e. standard abdominal binder), and active compression (device prototype). Abdominal applied pressure during device activation was measured by a strain-gauge manometer placed between the skin and binder. Systolic (SBP) and mean (MAP) arterial blood pressure was measured by standard blood pressure cuff in supine position followed by repeat measurements at 1 minute intervals for 5 minutes following upright position. A survey tool was administered to determine scores (1-10) for comfort and ease of donning abdominal binders. Results: Abdominal pressure increased from 0 to 15±3 mmHg upon device activation for both passive and active compression devices. During the transition from supine to an upright position, both active and passive compression devices demonstrated significantly higher MAP compared to the no-compression condition (67±4, 68±5, 62±5 respectively, P<0.05), but there was no statistically significant difference in SBP or MAP when comparing active to passive compression. Active compression demonstrated significantly higher comfort scores (8.3±1) compared to passive compression (3.2±2) but lower when compared to no compression (10). Subjects universally reported that active compression device was easier to don compared to passive device. Conclusions: Active or passive abdominal compression prevents hypotension associated with postural changes. Active compression is associated with increased comfort and ease of donning compared to passive compression devices. Future trials are warranted to investigate the efficacy of our device in patients with OH.Keywords: orthostatic hypotension, compression binder, abdominal binder, active abdominal compression
Procedia PDF Downloads 289986 Responsive Integrative Therapeutic Method: Paradigm for Addressing Core Deficits in Autism by Balkibekova
Authors: Balkibekova Venera Serikpaevna
Abstract:
Background: Autism Spectrum Disorder (ASD) poses significant challenges in both diagnosis and treatment. Existing therapeutic interventions often target specific symptoms, necessitating the exploration of alternative approaches. This study investigates the RITM (Rhythm Integration Tapping Music) developed by Balkibekova, aiming to create imitation, social engagement and a wide range of emotions through brain development. Methods: A randomized controlled trial was conducted with 100 participants diagnosed with ASD, aged 1 to 4 years. Participants were randomly assigned to either the RITM therapy group or a control group receiving standard care. The RITM therapy, rooted in tapping rhythm to music such as: marche on the drums, waltz on bells, lullaby on musical triangle, dancing on tambourine, polka on wooden spoons. Therapy sessions were conducted over a 3 year period, with assessments at baseline, midpoint, and post-intervention. Results: Preliminary analyses reveal promising outcomes in the RITM therapy group. Participants demonstrated significant improvements in social interactions, speech understanding, birth of speech, and adaptive behaviors compared to the control group. Careful examination of subgroup analyses provides insights into the differential effectiveness of the RITM approach across various ASD profiles. Conclusions: The findings suggest that RITM therapy, as developed by Balkibekova, holds promise as intervention for ASD. The integrative nature of the approach, addressing multiple domains simultaneously, may contribute to its efficacy. Further research is warranted to validate these preliminary results and explore the long-term impact of RITM therapy on individuals with ASD. This abstract presents a snapshot of the research, emphasizing the significance, methodology, key findings, and implications of the RITM therapy method for consideration in an autism conference.Keywords: RITM therapy, tapping rhythm, autism, mirror neurons, bright emotions, social interactions, communications
Procedia PDF Downloads 669985 Characterization of Surface Microstructures on Bio-Based PLA Fabricated with Nano-Imprint Lithography
Authors: D. Bikiaris, M. Nerantzaki, I. Koliakou, A. Francone, N. Kehagias
Abstract:
In the present study, the formation of structures in poly(lactic acid) (PLA) has been investigated with respect to producing areas of regular, superficial features with dimensions comparable to those of cells or biological macromolecules. Nanoimprint lithography, a method of pattern replication in polymers, has been used for the production of features ranging from tens of micrometers, covering areas up to 1 cm², down to hundreds of nanometers. Both micro- and nano-structures were faithfully replicated. Potentially, PLA has wide uses within biomedical fields, from implantable medical devices, including screws and pins, to membrane applications, such as wound covers, and even as an injectable polymer for, for example, lipoatrophy. The possibility of fabricating structured PLA surfaces, with structures of the dimensions associated with cells or biological macro- molecules, is of interest in fields such as cellular engineering. Imprint-based technologies have demonstrated the ability to selectively imprint polymer films over large areas resulting in 3D imprints over flat, curved or pre-patterned surfaces. Here, we compare nano-patterned with nano-patterned by nanoimprint lithography (NIL) PLA film. A silicon nanostructured stamp (provided by Nanotypos company) having positive and negative protrusions was used to pattern PLA films by means of thermal NIL. The polymer film was heated from 40°C to 60°C above its Tg and embossed with a pressure of 60 bars for 3 min. The stamp and substrate were demolded at room temperature. Scanning electron microscope (SEM) images showed good replication fidelity of the replicated Si stamp. Contact-angle measurements suggested that positive microstructuring of the polymer (where features protrude from the polymer surface) produced a more hydrophilic surface than negative micro-structuring. The ability to structure the surface of the poly(lactic acid), allied to the polymer’s post-processing transparency and proven biocompatibility. Films produced in this were also shown to enhance the aligned attachment behavior and proliferation of Wharton’s Jelly Mesenchymal Stem cells, leading to the observed growth contact guidance. The bacterial attachment patterns of some bacteria, highlighted that the nano-patterned PLA structure can reduce the propensity for the bacteria to attach to the surface, with a greater bactericidal being demonstrated activity against the Staphylococcus aureus cells. These biocompatible, micro- and nanopatterned PLA surfaces could be useful for polymer– cell interaction experiments at dimensions at, or below, that of individual cells. Indeed, post-fabrication modification of the microstructured PLA surface, with materials such as collagen (which can further reduce the hydrophobicity of the surface), will extend the range of applications, possibly through the use of PLA’s inherent biodegradability. Further study is being undertaken to examine whether these structures promote cell growth on the polymer surface.Keywords: poly(lactic acid), nano-imprint lithography, anti-bacterial properties, PLA
Procedia PDF Downloads 3319984 CO2 Gas Solubility and Foam Generation
Authors: Chanmoly Or, Kyuro Sasaki, Yuichi Sugai, Masanori Nakano, Motonao Imai
Abstract:
Cold drainage mechanism of oil production is a complicated process which involves with solubility and foaming processes. Laboratory experiments were carried out to investigate the CO2 gas solubility in hexadecane (as light oil) and the effect of depressurization processes on microbubble generation. The experimental study of sensitivity parameters of temperature and pressure on CO2 gas solubility in hexadecane was conducted at temperature of 20 °C and 50 °C and pressure ranged 2.0–7.0 MPa by using PVT (RUSKA Model 2370) apparatus. The experiments of foamy hexadecane were also prepared by depressurizing from saturated pressure of 6.4 MPa and temperature of 50 °C. The experimental results show the CO2 gas solubility in hexadecane linearly increases with increasing pressure. At pressure 4.5 MPa, CO2 gas dissolved in hexadecane 2.5 mmol.g-1 for temperature of 50 °C and 3.5 mmol.g-1 for temperature of 20 °C. The bubbles of foamy hexadecane were observed that most of large bubbles were coalesced shortly whereas the small one keeps presence. The experimental result of foamy hexadecane indicated large depressurization step (∆P) produces high quality of foam with high microbubble distribution.Keywords: CO2 gas solubility, depressurization process, foamy hexadecane, microbubble distribution
Procedia PDF Downloads 4939983 Effect of Downstream Pressure in Tuning the Flow Control Orifices of Pressure Fed Reaction Control System Thrusters
Authors: Prakash M.N, Mahesh G, Muhammed Rafi K.M, Shiju P. Nair
Abstract:
Introduction: In launch vehicle missions, Reaction Control thrusters are being used for the three-axis stabilization of the vehicle during the coasting phases. A pressure-fed propulsion system is used for the operation of these thrusters due to its less complexity. In liquid stages, these thrusters are designed to draw propellant from the same tank used for the main propulsion system. So in order to regulate the propellant flow rates of these thrusters, flow control orifices are used in feed lines. These orifices are calibrated separately as per the flow rate requirement of individual thrusters for the nominal operating conditions. In some missions, it was observed that the thrusters were operated at higher thrust than nominal. This point was addressed through a series of cold flow and hot tests carried out in-ground and this paper elaborates the details of the same. Discussion: In order to find out the exact reason for this phenomenon, two flight configuration thrusters were identified and hot tested in the ground with calibrated orifices and feed lines. During these tests, the chamber pressure, which is directly proportional to the thrust, is measured. In both cases, chamber pressures higher than the nominal by 0.32bar to 0.7bar were recorded. The increase in chamber pressure is due to an increase in the oxidizer flow rate of both the thrusters. Upon further investigation, it is observed that the calibration of the feed line is done with ambient pressure downstream. But in actual flight conditions, the orifices will be subjected to operate with 10 to 11bar pressure downstream. Due to this higher downstream pressure, the flow through the orifices increases and thereby, the thrusters operate with higher chamber pressure values. Conclusion: As part of further investigatory tests, two numbers of fresh thrusters were realized. Orifice tuning of these thrusters was carried out in three different ways. In the first trial, the orifice tuning was done by simulating 1bar pressure downstream. The second trial was done with the injector assembled downstream. In the third trial, the downstream pressure equal to the flight injection pressure was simulated downstream. Using these calibrated orifices, hot tests were carried out in simulated vacuum conditions. Chamber pressure and flow rate values were exactly matching with the prediction for the second and third trials. But for the first trial, the chamber pressure values obtained in the hot test were more than the prediction. This clearly shows that the flow is detached in the 1st trial and attached for the 2nd & 3rd trials. Hence, the error in tuning the flow control orifices is pinpointed as the reason for this higher chamber pressure observed in flight.Keywords: reaction control thruster, propellent, orifice, chamber pressure
Procedia PDF Downloads 2019982 Clinical Efficacy of Nivolumab and Ipilimumab Combination Therapy for the Treatment of Advanced Melanoma: A Systematic Review and Meta-Analysis of Clinical Trials
Authors: Zhipeng Yan, Janice Wing-Tung Kwong, Ching-Lung Lai
Abstract:
Background: Advanced melanoma accounts for the majority of skin cancer death due to its poor prognosis. Nivolumab and ipilimumab are monoclonal antibodies targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocytes antigen 4 (CTLA-4). Nivolumab and ipilimumab combination therapy has been proven to be effective for advanced melanoma. This systematic review and meta-analysis are to evaluate its clinical efficacy and adverse events. Method: A systematic search was done on databases (Pubmed, Embase, Medline, Cochrane) on 21 June 2020. Search keywords were nivolumab, ipilimumab, melanoma, and randomised controlled trials. Clinical trials fulfilling the inclusion criteria were selected to evaluate the efficacy of combination therapy in terms of prolongation of progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The odd ratios and distributions of grade 3 or above adverse events were documented. Subgroup analysis was performed based on PD-L1 expression-status and BRAF-mutation status. Results: Compared with nivolumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR in combination therapy were 0.64 (95% CI, 0.48-0.85; p=0.002), 0.84 (95% CI, 0.74-0.95; p=0.007) and 1.76 (95% CI, 1.51-2.06; p < 0.001), respectively. Compared with ipilimumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR were 0.46 (95% CI, 0.37-0.57; p < 0.001), 0.54 (95% CI, 0.48-0.61; p < 0.001) and 6.18 (95% CI, 5.19-7.36; p < 0.001), respectively. In combination therapy, the odds ratios of grade 3 or above adverse events were 4.71 (95% CI, 3.57-6.22; p < 0.001) compared with nivolumab monotherapy, and 3.44 (95% CI, 2.49-4.74; p < 0.001) compared with ipilimumab monotherapy, respectively. High PD-L1 expression level and BRAF mutation were associated with better clinical outcomes in patients receiving combination therapy. Conclusion: Combination therapy is effective for the treatment of advanced melanoma. Adverse events were common but manageable. Better clinical outcomes were observed in patients with high PD-L1 expression levels and positive BRAF-mutation.Keywords: nivolumab, ipilimumab, advanced melanoma, systematic review, meta-analysis
Procedia PDF Downloads 138