Investigation of cost-effectiveness of highway asphalt pavement maintenance treatments based on rutting development analysis

To investigate the cost-effectiveness of different maintenance treatments of highways in Jiangsu Province, the historical pavement maintenance records, traffic load information and pavement performance data in the pavement management system （PMS） are recorded and analyzed. Compared with the growth model, the linear model, the logarithm model and the exponential model, the cubic model has higher regression accuracy R2 and it can capture the sigmoid shape of the deterioration curve. So it is selected to simulate the pavement rotting development. The benefit over cost ratio is calculated to quantify the treatment cost- effectiveness. The analysis results show that thin hot mix asphalt （HMA） overlays and micro surfacing are more cost- effective than the. other two treatments on light and moderate traffic roads. Hot in-place recycling and thick HMA overlays have much longer service lives and greater cost-effectiveness under heavy or extra heavy traffic.

Reliability and Validity of Addiction Severity Index in Drug Users with Methadone Maintenance Treatment in Guizhou Province, China

Objective To evaluate the reliability and validity of the Chinese version of addiction severity index （ASI）-5th version （ASI-C-5）, in illegal drug users receiving methadone maintenance treatment （MMT） in China. Methods One hundred and eighty-six heroin addicts （144 men and 42 women） receivihg MMT at three clinics in Guizhou province, southwest China, were recmited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability. Results Cronbach＇s alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores （CSs） of ASI-C-5 were satisfactory （r=0.38-0.97）. Based on item analysis and expert＇s suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts＇ self-rating anxiety scale （SAS） and self-rating depression scale （SDS） （r=0.59 and 0.45） except for social support rating scale （SSRS）. Conclusions ASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.

Comparing the efficacy of different dexamethasone regimens for maintenance treatment of multiple myeloma in standard-risk patients non-eligible for transplantation

BACKGROUND Multiple myeloma(MM)is a plasma cell malignancy,while MM outcomes have significantly improved due to novel agents and combinations,MM remains an incurable disease.The key goal of treatment in MM is to achieve a maximal response and the subsequent consolidation of response after initial therapy.Many studies analyzed an improved progression-free survival(PFS)following lenalidomide alone maintenance versus placebo or observation after autologous stem cell transplant(ASCT)in patients with NDMM.In the SWOG S0777 clinical trial,patients newly diagnosed with MM(NDMM)without ASCT received lenalidomide plus low-dose dexamethasone(DXM)maintenance until progressive disease,where PFS and overall survival(OS)were significantly improved.In the present study,we assessed the efficacy and toxicity of the different doses of DXM combined with lenalidomide for maintenance treatment of NDMM for transplant noneligible patients in the standard-risk group.AIM To investigate the efficacy and adverse effects of different administration modes of DXM combined with lenalidomide for maintenance treatment of MM in standard-risk patients ineligible for transplantation.METHODS A total of 96 MM patients were enrolled in this study,among whom 48 patients received maintenance treatment that consisted of oral administration of 25 milligrams(mg)of lenalidomide from days 1-21 and 40 mg of DXM on days 1,8,15,and 22(DXM 40 mg group),repeated every 4 wk.Another group was treated with oral administration of 25 mg of lenalidomide from days 1-21 and 20 mg of DXM on days 1-2,8-9,15-16,and 22-23(DXM 20 mg group),which was also repeated every 4 wk.RESULTS The median PFS was 37.25 mo in the DXM 40.00 mg group and 38.17 mo in the DXM 20 mg group(P=0.171).The median OS was 50.78 mo in the DXM 40 mg group and 51.69 mo in the DXM 20 mg group(P=0.171).Fourteen patients in the DXM 40 mg group and 6 patients in the DXM 20 mg group suffered from adverse gastrointestinal reactions after the oral administration of the DXM tablet(P=0.044).Ten patients suffered from abnormal glucose tolerance(GTA),impaired fasting glucose(IFG),or diabetes mellitus in the DXM 40 mg group during our observation time compared to 19 patients with GTA,IFG,or DM in the DXM 20 mg group(P=0.033).Abnormalβ-crosslaps or higher were found in 5 patients in the DXM 40 mg group and 12 patients in the DXM 20 mg group(P=0.049).Insomnia or an increase in insomnia compared to the previous condition was evident in 2 patients in the DXM 40 mg group after maintenance treatment for more than 6 mo compared to 11 patients in the DXM 20 mg group(P=0.017).CONCLUSION The DXM 40 mg group exhibited efficacy similar to that of the DXM 20 mg group.However,the DXM 40 mg group had significantly decreased toxicity compared with the DXM 20 mg group in the long term.

Pilot Study of Problem Gambling in Specialized Substance Use Disorder Treatment—High Lifetime Prevalence of Problem Gambling in Opioid Maintenance Treatment Patients

Problem gambling is over-represented in patients treated for substance use disorders, but substance-specific prevalence of problem gambling is rarely reported. In specialized addiction treatment facilities for opioid maintenance treatment and for alcohol and prescription drug dependence, respectively, 129 patients were screened for problem gambling using the NODS-CLiP. The lifetime prevalence of problem gambling was markedly higher in opioid maintenance treatment (61 percent) than in alcohol and prescription drug dependence treatment (11 percent, p < 0.001). When controlling for gender and age, problem gambling remained significantly associated with opioid maintenance treatment. The present study demonstrated a very high prevalence of lifetime problem gambling in opioid maintenance treatment patients. This calls for active screening for problem gambling in substance use disorder patients, and mainly in treatment for opioid dependence.

Recent advances in the treatment of opioid use disorders–focus on long-acting buprenorphine formulations

Oral methadone or sublingual buprenorphine are first-line medications for pharmacotherapy of opioid use disorders(OUDs).Three long-acting buprenorphine depot or implant formulations are currently available for the treatment of OUDs:(1)CAM 2038(Buvidal)for subcutaneous weekly and monthly application;(2)RBP-6000(Sublocade^(TM))as a monthly depot formulation;and(3)A six-month buprenorphine implant[Probuphine^(TM)].The pharmacology,clinical efficacy and prospects of these medications are discussed.

The observation of single-agent gemcitabine maintenance therapy in patients with metastatic breast cancer

Objective:The aim of the study was to evaluate the efficacy and tolerability of single-agent gemcitabine in the maintenance treatment of histologically confirmed metastatic breast cancer cases.Methods:The 45 patients carried efficacious chemotherapy were divided into maintenance therapy group(n=23) and control group(n=22) according to the different treatment methods.Patients in the maintenance therapy group received gemcitabine therapy until 6 cycles,disease progression or adverse effect intolerance.Within the control group,the patients were given best supportive care.Follow-up was made until disease progression,death or 2 years.The short-term clinical efficacy and adverse effects,progression-free survival(PFS) and median survival of recurrence(MSR) of these two groups were compared and analyzed.Results:Compared with the control group,the experiment group had higher response rate(RR;73.9% vs 31.8%;P<0.05),and significantly progress of median PFS(13.1 vs 9.6 months;P<0.05).However,the progression of MSR had no statistically difference with the control group(23.3 vs 21.1 months;P>0.05).Most of the treatment-related adverse events were mild,and the most common adverse event was hematologic toxicity.The 3 cases occurred grades 3–4 neutropenia and 3 cases occurred grades 3–4 thrombocytopenia.The 1 patient stopped treatment because of grade 3 allergic reaction,and 4 patients required dose reduction for grade 4 adverse events.Other adverse effects were grades 1–2,and all were recovered after symptomatic treatment.There was no significant side effect which threatened the life.Conclusion:In the extension maintenance treatment,gemcitabine can consolidate the therapeutic effect in advance and significantly prolong median PFS of metastatic breast cancer patients.In conclusion,gemcitabine monotherapy with a favorable safety profile is an effective maintenance treatment in metastatic breast cancer patients.

Systemic chemotherapy for metastatic breast cancer

Breast cancer is the leading cause of cancer among women worldwide and the most common cancer in China. Many factors influence the treatment strategy for metastatic breast cancer （MBC）. Chemotherapy should be administered to patients with hormone receptor-negative tumors, symptomatic visceral metasta- sis, and a short disease-free interval. Sequential single-agent chemotherapy has similar efficacy as combi- nation agents in terms of overall survival and quality of life. Anthracyclines are the cornerstone of first-line treatment for MBC, and taxanes represent the second treatment option after resistance. When progression or intolerable toxicity occurs after optimal treatment, the alternative treatments include capecitabine, vinorel- bine, and gemcitabine. Ixabepilone and eribulin are relatively new effective single agents. A combination of cytotoxic agents for patients with rapid clinical progression can further improve the overall response rate and time to progression compared to single-agent treatment. For patients with MBC who were pretreated with anthracyclines in the neoadjuvant/adjuvant setting, a taxane-containing regimen such as docetaxel plus capecitabine or gemcitabine plus paclitaxel should be administered. Platinum-based therapies such as cisplatin or carboplatin have a role in the treatment of triple-negative breast cancer. Meanwhile, the efficacy of the addition of targeted drugs such as iniparib, bevacizumab, and catuximab to chemotherapy remains unproven. Maintenance chemotherapy is routinely recommended in clinical practice at present. Patients who were previously treated with paclitaxel and gemcitabine have better progression-free and overall sur- vival with maintenance chemotherapy according to a Korean phase III clinical trial. Sequential maintenance treatment with capecitabine monotherapy after capecitabine-based combination chemotherapy （X-based X） appears favorable based on a series of domestic studies.

Adalimumab in ulcerative colitis: Two cases of mucosal healing and clinical response at two years

Infliximab (IFX) is currently the only biologic therapy used in the treatment of moderate-to-severe ulcerative colitis (UC). In the years to come, more biologic therapies will have a role in the management of moderate-to-severe UC. We report on two patients with steroid-dependent UC who, due to adverse reactions to IFX, have been under therapy with adalimumab for two years. Both patients received concomitant immunosuppressive treatment. Long term clinical remission and mucosal healing are described.

Are we giving azathioprine too much time?

Azathioprine is currently the key drug in the maintenance treatment of inflammatory bowel diseases. However, there are still some practical issues to be resolved: one is how long we must maintain the drug. Given that inflammatory bowel diseases are to date chronic, non-curable conditions, treatment should be indefinite and only the loss of efficacy or the appearance of serious side effects may cause withdrawal. As regards to efficacy and their maintenance over time, evidence supports the continuous usefulness of the drug in the long term: in fact its withdrawal very substantially increases the risk of relapse. About side effects, azathioprine is a relatively well tolerated drug and even indefinite use seems safe. The main theoretical risks of prolonged use would be the myelotoxicity, hepatotoxicity, and the development of cancer. In fact, serious bone marrow suppression or serious liver damage are uncommon, and can be minimized with proper use of the drug. Recent metanalysis suggests that the risk of lymphoma is real, but the individual risk is rather low, and decision analysis suggests a favorable benefit/risk ratio in the long term. Therefore, in patients with inflammatory bowel diseases in whom azathioprine is effective and well tolerated, the drug should not be stopped. This recommendation concerns the use of azathioprine as a single maintenance drug, and is not necessarily applicable to patients receiving concomitant biological therapy.

Effect of Feitai Capsule(肺泰胶囊) on Quality of Life and Progression-Free Survival of Patients with Unresectable Non-Small Cell Lung Cancer

Objective： To examine the effect of a Chinese medicinal herbal formula （Feitai Capsule, 肺泰胶囊） on the quality of life （QOL） and progression-free survival （PFS） of patients with unresectable non-small cell lung cancer （NSCLC）. Methods： Sixty-two patients were randomly divided into the treatment group （31 cases） and the control group （31 cases）. For the treatment group, 4 capsules （1.2 g/capsule） of Feitai Capsule were administered 3 times a day after meals for 3 weeks; then no drug was administered for 1 week. This schedule was continued for at least 3 more cycles （12 weeks totally）. If there were no obvious toxic reactions, the treatment was extended. The patients were evaluated at least once every 8 weeks until progressive dJsease （PD）. For the control group, the regular follow-up and evaluation were performed at least once every 8 weeks until PD. Clinical symptoms, objective response, physical constitution and energy, QOL, and PFS were evaluated regularly. Analysis of variance （ANOVA）, a non-parametric test, and analysis of covariance were used to compare clinical features, amelioration of clinical symptoms, physical constitution and energy, and QOL. Kaplan- Meier analysis was used to compare the two-group PFS. Results： Sixty patients finished the final evaluation, with 30 patients in each group. Baseline characters between groups were not significantly different （P〉0.05）. The control group had a 36.7% improvement in clinical symptoms, while the treatment group had a 73.3% improvement. This difference was statistically significant （Z=-2.632, P=0.008）. The control group had a 26.7% improvement in the Karnofsky performance status （KPS）, while the treatment group had a 53.4% improvement. This was also significantly different （Z=-2.182, P=0.029）. A comparative analysis indicated a positive correlation （r=0.917, P〈0.001）. Compared with the control group, QOL in the treatment group was significantly improved, except in the social/family condition and doctor-patient relationship indicators. The PFS of the treatment group and control group were 6.23 months and 4.67 months, respectively （P=0.048）. Conclusion： Feitai Capsule, a Chinese medicinal herbal treatment could improve the QOL and extend the PFS of the unresectable NSCLC patients.

Curative effect of acupuncture and moxibustion on insomnia: a randomized clinical trial

OBJECTIVE: To observe the effect of acupuncture and moxibustion on insomnia and explore its mechanism. METHODS: One hundred and twenty patients were randomly divided into an experiment group and a control group. Sixty patients in the experiment group were treated once a day with acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Shenmai (BL 62), and Zhaohai (KI 6) and with moxibustion at Baihui (GV 20) and Sishencong (EX-HN 1). Sixty patients in the control group were acupunctured once a day at Shenmen (HT 7), Neiguan (PC 6), and Sanyinjiao (SP 6).The Pittsburgh Sleep Quality Index (PSQI) was used to compare sleep improvement between the two groups. RESULTS: The total effective rate was 87.7% in the experiment group and 76.3% in the control group. The PSQI scores and the total score were lower after treatment than before treatment in bothgroups. However, the reduction in the experiment group was greater than that in the control group in sleeping quality, time to fall asleep, sleeping disorder, and daytime function (P<0.05). CONCLUSION: Acupuncture and moxibustion at Baihui (GV 20), Sishencong (EX-HN 1), Shenmai (BL 62), and Zhaohai (KI 6) significantly improved insomnia symptoms in the experiment group compared with the control group.