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Objectives To systematically evaluate the efficacy and safety of Arbidol and lopinavir/ritonavir (LPV/r) in the treatment of coronavirus disease 2019(COVID-19) using a meta-analysis method. Methods The China Knowledge Network, VIP database, WanFang database PubMed database, Embase database, and Cochrane Library were searched for a collection of comparative studies on Arbidol and lopinavir/ritonavir in the treatment of coronavirus disease 2019. Meta-analysis was used to evaluate the efficacy and safety of Arbidol and lopinavir/ritonavir in the treatment of COVID-19. Results The results of the systematic review indicated that Arbidol had a higher positive-to-negative conversion rate of SARS-CoV-2 nucleic acid on Day 7 [P=0.03], a higher positive-to-negative conversion rate of SARS-CoV-2 nucleic acid on Day 14 [P=0.006], a higher improvement rate of chest CT on Day 14 [P=0.02], a lower incidence of adverse reactions [P=0.002] and lower rate of mortality[P=0.007]. There was no difference in the rate of cough disappearance on Day 14 [P=0.24] or the rate of severe/critical illness [P=0.07] between the two groups. Conclusions Arbidol may be superior tolopinavir/ritonavir in the treatment of COVID-19. However, due to the small number of included studies and the number of patients, high-quality multi-centre large-sample randomized double-blind controlled trials are still needed for verification. This article is protected by copyright. All rights reserved.

AIMS To compare efficacy and safety between neurogenic and non-neurogenic women after adjustable continence therapy (ACT®) balloons implantation to treat stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. METHODS In the present retrospective multicentric study, all neurogenic and non-neurogenic women implanted with ACT® balloons between 2000 and 2018 were considered for inclusion. Efficacy was compared 1 year after implantation, and women were allocated in three different groups as follows. Success: maximum 1 pad per day and patient's impression of improvement assessed using a numeral rating scale (NRS) ≥8/10. Improvement: decrease of daily pad use and/or NRS ≥5/10. Failure: increase or stability of daily pad use or NRS

The topical antifungal efinaconazole was applied to 27 nails (17 patients), and the treatment effects were monitored over a stipulated period (after 3, 6, and 12 months). Fourteen nails were observed for 18 months. Effects of the treatment were determined on the basis of the improvement rate of the turbidity ratio compared with that before treatment. After 12 months, five nails were cured and marked improvement was noted, whereas moderate and marked improvements were noted in 11 and six nails, respectively. The cured patients exhibited a significantly better improvement rate at 6 months (68.8%) than the other groups. Only 10.6% improvement was observed at the same point in time for the mild improvement group. Thus, in cases where the improvement rate after 6 months of treatment was 10% or less, it was judged that oral treatment should be considered. Furthermore, of the nails monitored for 18 months, those that exhibited further growth in improvement rates at 12 months was 51.6%, suggesting that an improvement rate of 50% at 12 months after starting treatment could be used as an indicator to determine switching to oral treatment.

Polypropylene; Polyvinylidene fluoride; Stress urinary incontinence Polipropileno; Fluoruro de polivinilideno; Incontinencia urinaria de esfuerzo Polipropilè; Fluorur de polivinilidè; Incontinència urinària d'esforç Aims: To compare the effectiveness and safety of polypropylene (PP) and polyvinylidene fluoride (PVDF) transobturator tapes (TOT) for the treatment of female stress urinary incontinence (SUI). Methods: This is a multicentre randomized trial. Women with SUI or stress-predominant mixed urinary incontinence and scheduled for a TOT procedure were randomized to PP or PVDF slings. The primary outcome was 1-year cure or improvement rate using composite criteria. Complications were also compared. Relationships with outcomes were analyzed using multivariable logistic regressions models. Results: From April 2016 to January 2018 285 participants were randomized. PP and PVDF slings showed similar high cure or improvement rate (91.0% vs. 95.6%, p = .138). Improvement in validated questionnaires was also similar. PVDF slings were associated with a lower rate of de novo urgency incontinence (adjusted odds ratio = 0.35; 95% confidence interval = 0.15-0.80). We found no statistical differences in complications rates, although a higher incidence of long-term pain events were observed in the PP group. The study is underpowered to find differences in specific complications owing to the low number of events. Conclusion: PP and PVDF TOTs are equally effective, although PVDF is associated with fewer cases of de novo urgency incontinence. Further studies are needed to give robust conclusions on safety profiles.

Objectives To examine improvement in acute low back pain (LBP) using ultrasound‐guided hydrorelease of the multifidus muscle. Methods This prognostic cohort study was conducted in a private clinic on samples of 75 patients with acute LBP diagnosed based on physical and imaging findings. Hydrorelease of the multifidus muscle was performed at the L4/5 level. The LBP visual analog scale (VAS) scores (cm) before and 5 minutes after hydrorelease were statistically evaluated. We defined improvement rate (%) as {LBP VAS scores (cm) immediately before hydrorelease – LBP VAS scores (cm) 5 minutes after hydrorelease} × 100 / LBP VAS scores (cm) immediately before hydrorelease and examined the correlation of the Heckmatt score and average age with the improvement rate. Results LBP VAS scores (cm) before and 5 minutes after hydrorelease were 7.19 ± 1.01 (mean ± SD) and 2.85 ± 1.25, respectively (p

Although economic theory suggests that both sales and fuel costs affect technology adoption by vehicle manufacturers, there is very little empirical evidence on either effect. We document a strong connection between a vehicle's sales and its energy efficiency. Using a demographics‐driven demand shifter to isolate demand‐side changes in sales, we find that a one standard deviation increase in sales raises efficiency by 0.2%, compared with a mean improvement rate of 1.4% per year between 1997 and 2013. Higher fuel prices also increase technology adoption directly by increasing willingness to pay for fuel cost savings. The results have two implications: manufacturers will continue to focus technological improvements on top selling vehicles; and fuel taxes will have larger effects on technology adoption than fuel economy standards and feebates.

Background No data on the clinical results and safety profiles of the polycaprolactone (PCL) -based dermal filler for crow's feet correction have been published. Aims This study was designed to compare the efficacy and safety of a novel PCL-based dermal filler, DLMR01, with that of RJR, a purified polynucleotide dermal filler. Patients/methods A total of 30 subjects with symmetric crow's feet of 2-4 points on the Crow's Feet Grading Scale (CFGS) were enrolled in this randomized, patient/evaluator-blinded, split-face study. Each subject was randomized to receive injections of DLMR01 or RJR in their right or left crow's feet. At 4 and 12 weeks, all participants were evaluated via CFGS, Global Aesthetic Improvement Scale (GAIS), and PRIMOS software system. Results No significant difference in CFGS, GAIS, and Ra value was detected between DLMR01 side and RJR at 12 weeks (improvement rate in CFGS from baseline at week 12-DLMR01: 48.28% [14/29], RJR: 41.38% [12/29]). Conclusion The novel PCL-based dermal filler DLMR01 shows suitable efficacy and safety, widening the selection possibilities for clinicians and patients in the treatment crow's feet.

We treated tinea unguium (onychomycosis caused by dermatophytes) patients with efinaconazole 10% solution. All patients with tinea unguium who tested positive for fungi in fingernails and toenails, regardless of age or severity, were eligible for the treatment. The number of patients was 106, consisting of 43 men and 63 women with a mean age of 66.7 years. The patients were treated with efinaconazole for a mean treatment duration of 38.1 weeks. Therapeutic efficacy was rated on a 5-point scale as follows: "cured", "markedly improved", "improved", "slightly improved" or "no change". A single nail was selected in each patient as the target nail. Selected nails were the big toenails with less than 50% involvement in 25 patients, the big toenails with 50% or more involvement in 52 patients, the fingernails in 10 patients and the second to fifth toenails in 19 patients with a mean treatment duration of 43.9, 38.1, 38.7 and 33.7 weeks, respectively. All groups showed an improvement in the percentage involvement from 30.6% to 9.8%, 77.6% to 35.7%, 82.7% to 17.6% and 80.3% to 15.5%, respectively (P < 0.01). The improvement rate (i.e. percentage of those rated as improved and better) was 76.0%, 65.4%, 80.0% and 89.5%, respectively. Efinaconazole 10% topical solution is beneficial for patients, regardless of age, severity or clinical type.

SummaryObjective To investigate the clinical application and efficacy of intradermal injection of low molecular weight hyaluronic acid (LMW-HA) for treating enlarged facial pores. Methods From January 2015 to May 2016, 42 subjects who sought aesthetic treatment underwent intradermal injection of LMW-HA to improve enlarged facial pores. For each treatment, 2.5 mL (25 mg) of LMW-HA was injected into the skin of the full face. The treatment was repeated 2-5 times with an interval of 1 to 1.5 months between consecutive treatments. The postoperative follow-up period was 1 to 6 months. Statistical analysis was used to compare the degree of enlargement of facial pores before and after injection. The clinical efficacy and adverse effects were recorded. Results The enlarged facial pores before and after treatment were categorized and subjected to the Wilcoxon matched-pairs signed-rank test. The difference was statistically significant (P

Objective The Attention Training Technique (ATT; Wells, 1990) is a brief metacognitive treatment strategy aimed at remediating self-focused processing and increasing attention flexibility in psychological disorder. Method We systematically reviewed and examined the efficacy of ATT in clinical and nonclinical samples. Scientific databases were searched from 1990 to 2014 and 10 studies (total N = 295) met inclusion criteria. Single-case data were meta-analyzed using the improvement rate difference, and standardized between and within-group effect sizes (ESs) were examined across 4 analogue randomized controlled trials (RCTs). Results Single-case outcomes indicated that ATT yields large ES estimates (pooled ES range: 0.74–1.00) for anxiety and depressive disorders. Standardized ESs across the RCTs indicated that ATT yields greater treatment gains than reference groups across majority outcomes (adjusted Cohen's d range: 0.40–1.23). Conclusions These preliminary results suggest ATT may be effective in treating anxiety and depressive disorders and help remediate some symptoms of schizophrenia. Although a limited number of studies with small sample sizes warrants caution of interpretation, ATT appears promising and future studies will benefit from adequately powered RCTs.

Background and Objective To evaluate safety and efficacy of focused monopolar radio frequency (RF) device for non-invasive labia tissue tightening and improvement of labial laxity. Methods This prospective cohort study participants were 17 female subjects aged between 27 and 56 years with lax skin at the labia area. All subjects received four consecutive treatments at 7-day intervals with RF device (Exilis Protege IntimaR, BTL Industries Inc., Boston, MA). The primary efficacy outcome measure was defined as one or more point improvement on 1–4 scale for vulva appearance determined by three blinded evaluators. Digital photographs were taken at the baseline and 1 month after the last treatment. Sexual gratification was assessed with Female Sexual Functioning Index (FSFI) and patient discomfort by Visual Analogue Scale (VAS). Results An average 2.9 (of maximum 4) points improvement rate in vulvar appearance was observed (P

This study aimed to evaluate the effectiveness of positive systemic practice (PSP) in the context of a controlled trial. PSP is a model of family therapy for adolescent emotional and behavioural problems. A series of thirty-seven consecutive patients assigned to a PSP treatment group and thirty-five similar patients consecutively assigned to a waiting-list control group completed this trial. They were assessed at baseline (Time 1) and 16 weeks later (Time 2) using the strengths and difficulties questionnaire (SDQ) that evaluates adolescent emotional and behavioural problems, and the systemic clinical outcomes and routine evaluation (SCORE) that evaluates family functioning. The PSP group was also followed up 6 months later (Time 3). For trial completers, the clinical improvement rate on the SDQ in the treatment group (65%) was significantly greater than that of the control group (20%) at Time 2 and the improvement was maintained at Time 3 (60%). The amelioration in adolescent behaviour problems on the SDQ was correlated with improvement in family adjustment on the SCORE. Treatment completers reported a high level of treatment satisfaction with this model of family therapy. Practitioner points PSP is a promising model of family therapy for adolescent emotional and behavioural problems. A distinctive feature of the model is the provision, by a co-therapy team, of conjoint family sessions and parallel series of sessions to adolescents and parents. The model is described in a treatment manual.

The purpose of this study was to evaluate using lesion washout (WO) volume fraction as a biomarker to improve the characterization of suspicious breast lesions. Study lesions consisted of a total of 60 malignant tumors (BI‐RADS 6) and 62 suspicious lesions (BI‐RADS 4 or 5). The biopsies of these suspicious lesions resulted in a total of 30 malignant tumors and 32 benign lesions, respectively, yielding a 48.4% positive predictive value (PPV) of the biopsies. The mean and standard deviation of the lesion WO volume fraction of these 60 BI‐RADS 6 malignant tumors were first computed to establish a 99% sensitivity threshold value for malignant tumors, and then the biomarker was used to characterize the suspicious lesions. Using the biomarker would characterize all the malignant tumors as malignant, 12 out of the 32 benign lesions as benign, potentially resulting in a 24% improvement rate in the PPV of the biopsies (from 48.4% to 60%) and consequently a 22.5% reduction rate in the false‐positive rate of benign biopsies (from 51.6% to 40%). The lesion WO volume fraction biomarker could improve the computer‐based assessment of breast MRI by increasing the PPV of breast biopsies and reducing the number of unnecessary biopsies without compromising sensitivity. PACS number: 87.61.Tg, 87.19.Xj

Background Chronic spontaneous urticaria (CSU) is a common skin disorder, but its clinical course reported so far is largely variable, probably due to the heterogeneity of the clinical background of patients and pathogenesis of this disease. Methods To reveal the prognosis of refractory CSU, we retrospectively studied the patients who suffered from spontaneous urticaria for six weeks or longer at their first visit to our outpatient clinic, who were insufficiently controlled by a standard dose of antihistamine, and revisited from 2003 to 2009. Results Among 223 patients with CSU, 117 patients fulfilled the criteria mentioned above. Mean disease duration at first visit and mean duration of follow-up at our hospital were 27.4 ± 4.2 months and 18.7 ± 1.9 months, respectively. By using Kaplan–Meier methods, the estimated improved rates at 12 months, 24 months, and 60 months were 36.6%, 51.2%, and 66.1%, respectively. The overall improvement rate of childhood cases (

Removing support material from rapid prototyping part fabricated by fused deposition modeling is required when the object is completed. Removing support material from rapid prototyping part system rapidly and efficiently is an important concern because the product life cycle is shorter than before. Effects of pH value and temperature of solution on the removal efficiency of support material were investigated in this study. Both pH value and temperature of the solution contribute to the removal efficiency of support material. The saving in the removing time of up to 83.4% is achieved by integrating two effects. The trend equation of y = 293.42x + 544.72 is capable of predicting the removing time. Removing time (y) can be predicted directly from the volume of support material (x). The error rate can be controlled within 5.11%. Surface roughness improvement rate of up to 46.3% is achieved using the solution with a pH value of 13 and a temperature of 95°C.

Cyclosporin is a second-line modality for the treatment of psoriasis. The long-term efficacy of cyclosporin and potential adverse side-effects, however, are a concern to patients. Therefore, a cyclosporin microemulsion (Neoral), which is steadily absorbed at an ultra-low dosage (1-2 mg/kg per day) or low dosage (2-3 mg/kg per day), is currently recommended. The dose must be calculated based on patient bodyweight and the blood concentration monitored regularly, which is time-consuming. Furthermore, the concentration is related to the safety profile, but not to efficacy. We examined whether a fixed-dose cyclosporin microemulsion (100 mg/day) is effective for treating psoriasis. Enrolled patients (n = 40) were given either 100 mg cyclosporin emulsion once daily (group A) or 50 mg twice daily (group B), regardless of patient weight and condition, before meals in a randomized controlled study. Patient bodyweight ranged 50-80 kg. We assessed the serum cyclosporin concentration 1 h after administrating the medicine (C1 score), Psoriasis Area and Severity Index (PASI) score, quality of life, and the results of regular blood examinations. The improvement rate was 69.4 ± 4.8% in group A and 73.4 ± 4.3% in group B. PASI-50 was achieved by 82% in group A and 84% in group B. At 6 weeks, the number of patients with PASI-50 was significantly higher in group A than in group B. PASI-75 and -90 were also achieved in both groups with no significant difference between groups. Administration of a fixed-dose cyclosporin microemulsion (100 mg/day) is practical for second-line psoriasis treatment.

Background: The novel hybrid retinoid, retinyl retinoate, is a synthetic material that was designed to reduce the side effects of retinoic acid and to increase the stability of retinol. The formulation of the retinyl retinoate, however, is required to enhance skin permeation, and thus to increase the anti-wrinkle effect. Aim: To identify the efficacy of retinyl retinoate microsphere using biodegradable polymer as an anti-aging agent of cosmetics in treating females over 30 years old with periorbital wrinkles. Methods: The retinyl retinoate microsphere was prepared using the biodegradable polymer; polylactic acid (PLA). We also conducted two clinical studies with a total of 44 Korean women for 12 weeks. In the first clinical study, 20 patients completed a 12-week trial of cream A [3% PLA-retinyl retinoate (2%) microsphere] applied twice daily to the face. In the second clinical study, 24 patients completed a 12-week trial of cream B (0.06% retinyl retinoate) applied twice daily to the face. Efficacy was based on a global photodamage score, photographs, and image analysis using replicas and Visiometers every 4 weeks. Results: The PLA-retinyl retinoate microsphere was more effective for the permeation of retinyl retinoate than retinyl retinoate in itself. The cream A, which contains 3% PLA-retinyl retinoate (2%) microsphere, showed a statistically significant improvement in facial wrinkles (P

Background/purpose: Chemical peeling is becoming increasingly popular for skin rejuvenation in dermatological esthetic surgery. Conspicuous facial pores are one of the most frequently encountered skin problems in women of all ages. This study was performed to analyze the effectiveness of reducing conspicuous facial pores using glycolic acid chemical peeling (GACP) based on a novel computer analysis of digital-camera-captured images. Methods: GACP was performed a total of five times at 2-week intervals in 22 healthy women. Computerized image analysis of conspicuous, open, and darkened facial pores was performed using the Robo Skin Analyzer CS 50. Results: The number of conspicuous facial pores decreased significantly in 19 (86%) of the 22 subjects, with a mean improvement rate of 34.6%. The number of open pores decreased significantly in 16 (72%) of the subjects, with a mean improvement rate of 11.0%. The number of darkened pores decreased significantly in 18 (81%) of the subjects, with a mean improvement rate of 34.3%. Conclusion: GACP significantly reduces the number of conspicuous facial pores. The Robo Skin Analyzer CS 50 is useful for the quantification and analysis of ‘pore enlargement’, a subtle finding in dermatological esthetic surgery.

Inspired by the Toyota Production System, many multinational manufacturers have recently developed their own company-specific production systems. While there is a general consensus that these systems can boost plant performance, the literature does not offer an explanation for the pattern of this improvement. We propose that this pattern follows an S-curve: as a plant implements a company-specific production system, its performance improves slowly at first, then grows rapidly, then less rapidly, and, finally, the improvement rate tapers off. We developed this empirically grounded theory by using a case research methodology. The case is the implementation of the Volvo Production System (VPS) in Volvo Group’s 67 factories worldwide. The data were collected from different sources: a survey, Volvo’s formal audit process, and 40 plant visits, which included observations on the factory floor and 200 interviews with managers. We used locally weighted regression to discern the pattern of improvement directly from the data. The S-curve theory has significant managerial and theoretical implications. It suggests that managers should tailor their targets and action plans based on the level of maturity the plant has reached in implementing the company-specific production system. Knowledge of what to expect when implementing such a system fills a gap in the literature and offers explanations of the forces that shape the pattern of change in a plant’s performance during implementation.

Background: While a 75% improvement in the Psoriasis Area Severity Index score (PASI75) and a 90% improvement (PASI90) are widely used as indicators of therapeutic effectiveness, specific target improvement rates of Nail Psoriasis Severity Index (NAPSI) have not yet been established. Objectives: We have attempted to suggest NAPSI improvement rates that could be used to asses the therapeutic response of nail psoriasis, which corresponds to PASI75 and PASI 90 of skin psoriasis. Methods: A post hoc analysis of a phase IV, multicenter, open-label, real-world observational clinical trial, the MARCOPOLO study was conducted to establish standard NAPSI improvement rates. At 28 and 52 weeks, NAPSI improvement rates for each patient was calculated to estimate the cumulative number of patients that correspond to proportion of PASI75 and PASI90 responders. Results: At 28 weeks, PASI75 and PASI90 were achieved in 70.6% and 32.4% of patients, respectively. NAPSI improvement rates corresponding to PASI75 and PASI90 were 25% and 63%. We could select NAPSI25 and NAPSI65 for convenience. At 52 weeks, PASI improvement rates remained similar to that of 28 weeks, but the NAPSI improvement rates corresponding to PASI75 and PASI90 were NAPSI40 and NAPSI70, respectively. Conclusion: NAPSI25 and NAPSI40 could be used as the parameters of therapeutic response corresponding to PASI75 for patients with nail psoriasis in the early and late phase, respectively.

This paper examines effects of tacit and codified knowledge on performance improvement as organizations gain experience with a new technology. We draw from knowledge management and learning curve research to predict improvement rate heterogeneity across organizations. We first note that the same technology can present opportunities for improvement along more than one dimension, such as efficiency and breadth of use. We compare improvement for two dimensions: one in which the acquisition of codified knowledge leads to improvement and another in which improvement requires tacit knowledge. We hypothesize that improvement rates across organizations will be more heterogeneous for dimensions of performance that rely on tacit knowledge than for those that rely on codified knowledge (H1), and that group membership stability predicts improvement rates for dimensions relying on tacit knowledge (H2). We further hypothesize that when performance relies on codified knowledge, later adopters should improve more quickly than earlier adopters (H3). All three hypotheses are supported in a study of 15 hospitals learning to use a new surgical technology. Implications for theory and practice are discussed.

The time-course of the recovery of the hearing level after treatment in 90 patients with idiopathic sudden sensorineural hearing loss was examined. The improvement rate calculated relative to the hearing level of the opposite ear was investigated to estimate the hearing recovery. Follow-up audiograms were performed once per week for 1 month after treatment and once per month thereafter. There were two groups that differed with respect to the characteristics of hearing recovery. One group showed an improvement rate of over 50% at 1-2 weeks and a good improvement rate at 3 months after treatment. In the other group, the improvement rate did not reach 50% at 1-2 weeks, and the improvement rate was poor at 3 months after treatment. The patients with improvement rates of over 50% at 1-2 weeks had earlier initial visits and had mild hearing loss, whereas the patients with profound hearing loss had improvement rates under 50% and poor long-term prognosis. We conclude that the improvement rate at 1-2 weeks after treatment predicts the long-term prognosis for recovery of hearing level in patients with sudden sensorineural hearing loss.

The usefulness of 1 % terbinafine HCl (Lamisil®) cream for hyperkeratotic-type tinea pedis and its transfer into the horny layer were evaluated. Of the 36 patients enrolled in the study, 35 were retained for analysis and one was excluded due to inappropriate drug application. Hyperkeratotic-type tinea pedis was classified into three types: true hyperkeratotic-type, partial hyperkeratotic-type, and quasi-hyperkeratotic type. The overall clinical improvement rate was 95.5% (100% for true-, 80% for partial- and 96.2% for quasi-hyperkeratotic type). The overall fungal eradication rate was 88.6% (75% for true-, 100% for partial- and 88.5% for quasi-hyperkeratotic type). The overall efficacy rate was 88.6% (75% for true-, 100% for partial- and 88.5% for quasi-hyperkeratotic type). No adverse reactions were reported. Drug concentrations in the horny layer were 170.3, 228.5 and 249.2 ng mg -1 , respectively, 2, 4 and 12 weeks after starting the treatment. These concentrations are more than 50 000 times higher than the minimum inhibitory concentrations of terbinafine for dermatophytes. These findings indicate that terbinafine HCl (Lamisil®) cream is very useful for refractory hyperkeratotic-type tinea pedis when administered alone. The pharmacokinetic data also support the clinical and mycological findings.

Most cases of sudden sensorineural hearing loss (SHL) remain idiopathic, and the majority are unilateral. From 1989 to 1993, 823 patients with sudden SHL were evaluated. Of these, 14 (1.7%) had sudden bilateral SHL. We reviewed the charts of these 14 patients to compare sudden bilateral SHL with sudden unilateral SHL. Usually, bilateral SHL was asymmetric. Most bilateral cases received combined steroid and vasodilator treatment, while unilateral cases were more likely to receive only one of these treatments. By audiological criteria, 67% of bilateral SHL cases improved, while the improvement rate in unilateral SHL was 52%; however, this difference was not statistically significant. In bilateral SHL patients showing improvement, both ears responded. Bilateral SHL patients were older at the onset of hearing loss, had a higher incidence of vascular disease, and were more likely to have positive antinuclear antibody titer. Recognition of similarities and differences between sudden unilateral and bilateral SHL can help in counseling patients.

Background Oral sulfasalazine has been reported to be effective in patients with idiopathic cutaneous lichen planus (LP). Objectives Our purpose was to evaluate the efficacy of this drug in the treatment of generalized cutaneous lichen planus (GLP). In this study, we evaluated the effectiveness of the anti-inflammatory drug sulfasalazine for the treatment of GLP. Methods A total of 52 patients with GLP presenting at the outpatient clinic were enrolled in this double-blind, randomized, placebo-controlled, prospective study. Of these patients, 44 completed the period of study. The patients were randomly divided into two groups. One group received placebo and the other was given sulfasalazine maximum 2.5 g/day. The patients were evaluated at the third and sixth weeks of treatment for improvement rate and occurrence of complications. Results After 6 weeks of treatment, the rate of cutaneous lesions improvement was 9.6% (two patients) in the placebo group and 82.6% (19 patients) in the sulfasalazine group. The improvement rate of pruritus was 14.3% in the placebo group and 91.3% in the sulfasalazine group. Side-effects which were mild and tolerable were detected in 30.7% of patients, but three patients left the study because of side effects. Most of the reported side-effects included gastrointestinal upset and headache. Conclusions Statistically, sulfasalazine was more effective than placebo in reducing cutaneous lesions and improving pruritus after 6 weeks of treatment. According to our study, sulfasalazine is a relatively safe and effective treatment option and may be an alternative therapy for the treatment of generalized lichen planus.

Prior qualitative literature reviews about the use of neuroleptics in dementia suggest that they are “modestly effective” in treating agitation and that no single neuroleptic is better than another. To develop a more precise concept of the clinical efficacy of neuroleptics, a meta-analytic review of the existing literature was performed. From double-blind clinical trials that compared a neuroleptic with a placebo in agitated dementia patients, P values and effect-size estimates were obtained, and were assessed by metaanalytic techniques. Results indicated that neuroleptics were significantly more effective than placebo (one-tailed P = .004) and had a small effect size (r = .18). Clinically, neuroleptic treatment changed the improvement rate in agitated dementia patients from .41 to .59 (binomial effect-size display). This indicates that 18 of 100 dementia patients benefited from neuroleptic treatment (beyond that of placebo) and is consistent with the modest efficacy described in previous qualitative reviews. In six studies comparing thioridazine with another neuroleptic, and in five studies comparing haloperidol with another neuroleptic, metaanalysis results did not show that these two medications differed significantly from the comparison medications, which is not inconsistent with the opinion that no single neuroleptic is better than another.

Various treatments have been described for feline plasma cell pododermatitis. Doxycycline has been reported recently as an effective medical option. Plasmacytic pododermatitis was diagnosed clinically and histopathologically in 10 cats. Blood samples for haematological, biochemical and immunological evaluation were taken before treatment. Cats were administered doxycycline at a dosage of 10 mg/kg/day for 40 days and re-evaluated at 30 and 60 days. Biochemical evaluation was repeated at both rechecks. All were Domestic Short-haired cats, eight males (five neutered) and two females (one spayed), ranging in age from 6 months to 8 years. Duration of lesions prior to consultation ranged from 1 to 48 months. Lesions were present in multiple footpads in all cases and consisted of swelling and softening (100%), erythema (50%), exfoliation (60%) and ulceration (20%). Haematological and serological findings included: thrombocytopenia (70%), leucocytosis (40%), lymphopenia (30%), and mild to pronounced hypergammaglobulinaemia (100%). Four of nine cats were FIV positive, 9/9 were FeLV negative, and 4/4 were negative for leishmaniosis. Response to treatment was as follows: complete remission within 30 days (one cat), complete remission within 60 days (four cats), more than 50% improvement in lesions (four cats), no improvement (one cat), and lost to follow up (one cat). Hypergammaglobulinaemia was still present in five of nine cats at day 60. Therapy with doxycycline at 10 mg/kg/day resulted in a high improvement rate in cats with plasma cell pododermatitis. Thrombocytopenia, a previously unreported haematological finding, was detected in the majority of the cats. Funding: Italian Society of Veterinary Dermatology, Merial.

Functional endonasal sinus surgery (FESS) is becoming the procedure of choice for the surgical treatment of chronic and recurrent sinusitis in adults and children. Retrospective analysis of the charts of 513 adult and 260 pediatric patients who underwent FESS after failing to respond to optimal medical treatment revealed an improvement rate of approximately 80% for both age groups. Although high response rates and low complication rates were found for both groups, there were significant differences in indications, preoperative evaluation, operative technique, and methods of postoperative follow-up for children.

One hundred and thirty-seven patients underwent optical urethrotomy and have been followed up over a period of 3 years. The overall improvement rate was 66%. The results were unrelated to the length of history, the number of previous dilatations or the site of the lesion. However, traumatic strictures did significantly less well than the others. Although the procedure can be repeated, the chance of failure following the third or subsequent urethrotomy was much greater than after the first or second procedure. Urethrotomy for post-prostatectomy membranous strictures was followed by incontinence in 31% of patients. Otherwise the procedure was safe and should be the first choice of treatment for most patients with urethral strictures.

A sustained-release papaverine preparation (Pavavid Plateau Cape) was evaluated for is efficacy in relieving symptoms related to cerebrovascular insufficiency. The overall improvement rate in 37 patients whose ages ranged from 45 to 80 years, was 70 per cent. The most consistent benefit was obtained in patients whose symptoms were caused by cerebral ischemia but who did not show evidence of advanced arteriosclerosis or other cerebral damage. The symptom most frequently relieved was the most disturbing one—loss of memory or amnesia. Other symptoms relieved in over 50 per cent of the involved patients were vertigo, dizziness, incoordination and confusion. The younger patients and those whose symptoms were of shorter duration responded better than those with advanced cerebral circulatory disease. Since the aging process is progressive, therapy which is effective in delaying the cerebrovascular insufficiency associated with aging should be started immediately upon the appearance of signs of cerebral ischemia. The results obtained in this series indicate that papaverine has a place in the management of such patients because of its pronounced cerebral vasodilator action. Even in patients in whom the cause of the symptoms is in doubt, papaverine merits consideration for a therapeutic trial.

The literature on outcome research in marital therapy is reviewed. Issues considered include the nature of outcome criteria, the need to establish a base line against which to measure improvement, and therapeutic effectiveness as a function of treatment type and time-in-therapy. The overall improvement rate across a heterogeneous collection of patients, therapists, and treatment modalities was 66 per cent, suggesting, conservatively, at least a moderately positive therapeutic effect in light of the judgment that “spontaneous” rates appear to be much lower in marital than in individual therapy. Evidence of deterioration in marital therapy also was discovered. No support was found for the contention that co-therapy is more effective than treatment of the couple by a single therapist. The needs of future research in the outcome of marital therapy are discussed and possible fruitful directions for such investigations suggested.