bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous SLAP Lesion Repair Technique Is an Effective Alternative to Portal of Wilmington
Authors: Galano Gregory J. , Ahmad Christopher S. , Bigliani Louis , Levine William
Published: November 2010

Athletes with superior labral tear from anterior to posterior (SLAP) lesions place large demands on their rotator cuff and often have partial articular-sided rotator cuff tears as part of an internal impingement process. A percutaneous technique that facilitates SLAP repair may decrease the rotator cuff morbidity associated with establishment of the standard Wilmington portal. The current study reports the clinical outcome of patients with SLAP lesions treated with a percutaneous repair technique. Twenty-two patients with SLAP lesions underwent percutaneous repair. Mean patient age was 26.9 years. Standard posterior viewing and anterior working portals were used. Anchor placement and suture passing were performed with a 3-mm percutaneous and transtendinous approach to the superior labrum. Knot tying was performed via the standard anterior working portal. Clinical outcomes were assessed with validated shoulder evaluation instruments. Mean follow-up was 31.1 months (±6.6 months). Improvement of shoulder evaluation scores from pre- to postoperative were as follows: American Shoulder and Elbow Surgeons score improved from 49.5 to 83.6, visual analog scale improved from 5.4 to 1.5, and Simple Shoulder Score improved from 6.4 to 11.0. All were significant improvements (
P
<.05). There was no significant difference in functional scores between Type II lesions versus combined lesions, or between patients with or without a concurrent low-grade rotator cuff tear. Ninety percent of athletes were able to return to sport at pre-injury level of function. Percutaneously-assisted arthroscopic SLAP lesion repair may minimize surgical morbidity to the rotator cuff and provides excellent results.
A Nonphosphaturic Mesenchymal Tumor Mixed Connective Tissue Variant of the Sacrum
Authors: Mavrogenis Andreas F. , Sakellariou Vasileios I. , Soultanis Konstantinos , Mahera Helen , Korres Demetrios S. , Papagelopoulos Panayiotis J.
Published: November 2010

Tumor-induced or oncogenic osteomalacia is a rare paraneoplastic syndrome characterized by overproduction of fibroblast growth factor-23 as a phosphaturic agent and renal phosphate wasting. A range of predominantly mesenchymal neoplasms have been associated with tumor-induced osteomalacia and classified as phosphaturic mesenchymal tumor mixed connective tissues. However, phosphaturic mesenchymal tumor mixed connective tissues could be nonphosphaturic in the first stage of the disease, either because the tumors are resected early in the clinical course or because the patient’s osteomalacia was attributed to another cause. This article presents a case of a 42-year-old woman with a 2-year history of low back and right leg pain. Laboratory examinations including serum and urine calcium and phosphorous were within normal values. Imaging of the lumbar spine and pelvis showed an osteolytic lesion occupying the right sacral wing. Histology was unclear. Reverse-transcription polymerase chain reaction analysis for fibroblast growth factor-23 was positive and confirmed the diagnosis of phosphaturic mesenchymal tumor mixed connective tissues. Preoperative selective arterial embolization and complete intralesional excision, bone grafting, and instrumented fusion from L4 to L5 to the iliac wings bilaterally was performed. Postoperative recovery was uneventful. Neurological deficits were not observed. A lumbopelvic corset was applied for 3 months. At 12 months, the patient was asymptomatic. Serum and urine values of calcium and phosphorous were normal throughout the follow-up evaluation.
Avascular Necrosis of the Capitate
Authors: Toker Serdar , Ozer Kagan
Published: November 2010

Although a large portion of the capitate is supplied by a single nutrient vessel, avascular necrosis of the capitatum is a rare condition. Its etiology is not clear, but a number of factors are linked to its pathogenesis including: repetitive trauma, dorsal instability of the carpus, Gaucher disease, systemic lupus erythematosus, gout, and steroid use.

A 24-year-old woman presented with right wrist pain of 12 months duration. She reported no major trauma and reported that her pain had begun during the third month of her pregnancy. She had a history of hyperemesis gravidarum treated with 2 to 4 mg/daily of prednisone during her pregnancy for 6 weeks. She had 70° extension and 45° flexion of her wrist. Radiographs showed a hypodense area at the capitate head and midcarpal joint arthritis. Magnetic resonance imaging demonstrated avascular necrosis of the capitate and midcarpal collapse at the lunocapitate joint. Lunocapitate fusion with a partial scaphoidectomy was performed. At final follow-up 28 months postoperatively, she had 60° of volar flexion, and 50° of dorsiflexion. She was pain free in the majority of her activities of daily living.

A small dose of steroid use during pregnancy, even in a short period of time, is a potential risk for avascular necrosis of the capitate and patients with a gradual onset of wrist pain during pregnancy may need to be investigated further if symptoms are not resolved with basic nonoperative measures within a reasonable time frame.
Integrated Methods for Teaching Population Health
Authors: Sistrom Maria Gilson , Zeigen Laura , Jones Melissa , Durham Korana Fiol , Boudrot Thomas
Published: November 2010

The Institute of Medicine recommends reforms to public health education to better prepare the public health workforce. This study addresses the application of two of the recommended reforms in the population health nursing curriculum at one university: use of an ecological model and distance learning methods. Using interdisciplinary faculty, integrated teaching and learning methods, and a multimedia curriculum, this study examined the following question: Can distance learning be designed to support learning goals and outcomes specific to an ecological approach and population health concepts in general? Course content was evaluated using students’ perception of practice utility and understanding of population health concepts. Integrated teaching methods were evaluated using a scale as well as comparison to other student distance learning experiences within the university. Findings demonstrated that both the ecological model and distance learning methods were successfully used to teach population health to a large nursing student cohort.
Modified Technique for Epinucleus Removal in Posterior Polar Cataract
Authors: Nagappa Somshekar , Das Sudeep , Kurian Mathew , Braganza Adrian , Shetty Rohit , Shetty Bhujang
Published: November 2010

The authors describe a novel technique for the removal of the sub-incisional epinucleus in cases of posterior polar cataracts. After the removal of the nucleus, the epinucleus is removed from the quadrant opposite to the section by aspiration using the phaco probe. Then hydrodissection is performed to dislodge the sub-incisional epinucleus, which is aspirated out. The rate of posterior capsular rupture decreased considerably with this technique because it reduced the manipulations required.
Three-Step Incision for 23-Gauge Vitrectomy Reduces Postoperative Hypotony Compared with an Oblique Incision
Authors: Shimozono Masataka , Oishi Akio , Kimakura Hiroki , Kimakura Mikiko , Kurimoto Yasuo
Published: November 2010

Background and Objective:

To assess the efficacy and safety of the newly developed three-step incision method of performing 23-gauge vitrectomy.

Patients and Methods:

A retrospective comparative study in which a consecutive series of 45 eyes that underwent the three-step incision type of 23-gauge vitrectomy was compared with a series of 27 consecutive eyes that had previously undergone the oblique incision type of 23-gauge vitrectomy.

Results:

No cases of postoperative hypotony (< 6 mm Hg) were noted in the three-step group compared with 3 cases (11%) in the oblique group (
P
= .05). The three-step incision resulted in a significantly higher mean intraocular pressure than the conventional incision on postoperative day 1 (14.1 ± 6.7 mm Hg vs 10.9 ± 3.7 mm Hg;
P
= .05), but there was no significant difference after 1 week.

Conclusion:

The three-step incision for performing 23-gauge vitrectomy effectively prevented postoperative hypotony and demonstrated a safety profile comparable to that of the oblique incision.
Successful Treatment of Superficial Corneal Irregularity by Lamellar Keratectomy Using the Femtosecond Laser
Authors: Choi Suk Kyue , Kim Jin Hyoung , Lee Doh , Moon Nam Joo
Published: November 2010

The authors report successful vision restoration after cataract surgery using a femtosecond laser in a patient with superficial corneal irregularity. A 62-year-old man with corneal irregularity and a cataract in the left eye was referred for treatment. The superficial corneal opacity causing the irregularity was mainly located within the superficial anterior cornea. To acquire a stable keratometric value, which is important for accurate calculation of intraocular lens power, lamellar keratectomy using a femtosecond laser (IntraLase; AMO, Irvine, CA) was performed to smooth the cornea surface. Postoperatively, corneal smoothness was restored and a stable keratometric value was acquired. Vision was improved with the expected refraction after cataract surgery. The femtosecond laser may be an effective surgical tool for patients with superficial corneal irregularity and cataracts.
Spontaneous Deflation of an Iris Pigment Epithelial Cyst Documented with AS-OCT
Authors: Kytasty Christina , Parvus Britt J. , Mahmood Zunair , Shields Carol L. , Shields Jerry A.
Published: November 2010

A 3-year-old girl presented with a black pupillary margin iris mass in the right eye diagnosed as an iris pigment epithelial (IPE) cyst, central (pupillary) type. The diagnosis was verified by anterior-segment optical coherence tomography (AS-OCT), which initially showed a circumscribed, round thin-walled cyst with clear lumen attached by a strand to the IPE. On follow-up 3 months later, the IPE cyst had deflated and AS-OCT showed an irregular collapsed surface with no lumen and optical shadowing. The authors report a case in which AS-OCT was used to provide information regarding the diagnosis and behavior of an IPE cyst.
Endogenous Fungal Endophthalmitis After Cardiac Surgery
Authors: Saffra Norman A. , Desai Rajen U. , Seidman Carly J. , Chapnick Edward K.
Published: November 2010

The authors present a single-patient interventional case report of endogenous fungal endophthalmitis (EFE) in a patient with an implanted prosthetic device. A 74-year-old man underwent a double coronary artery bypass graft with a bioprosthetic pericardial valve and transvenous dual chamber pacemaker. Four months later, he presented with EFE. Despite aggressive local and systemic antifungal therapy, the patient died of septic shock due to a fungally infected pacemaker. Successful management of post-cardiac surgery EFE requires aggressive local and systemic antifungal therapy, but without surgical removal of implanted thoracic hardware these modalities alone may be insufficient for a cure.
RoboSmith: Wireless Networked Architecture for Multiagent Robotic System
Authors: Floroian Dan , Ursutiu Doru , Floroian Laura , Moldoveanu Florin
Published: November 2010

In this paper is presented an architecture for a flexible mini robot for a multiagent robotic system. In a multiagent system the value of an individual agent is negligible since the goal of the system is essential. Thus, the agents (robots) need to be small, low cost and cooperative. RoboSmith are designed based on these conditions. The proposed architecture divide a robot into functional modules such as locomotion, control, sensors, communication, and actuation. Any mobile robot can be constructed by combining these functional modules for a specific application. An embedded software with dynamic task uploading and multi-tasking abilities is developed in order to create better interface between robots and the command center and among the robots. The dynamic task uploading allows the robots change their behaviors in runtime. The flexibility of the robots is given by facts that the robots can work in multiagent system, as master-slave, or hybrid mode, can be equipped with different modules and possibly be used in other applications such as mobile sensor networks remote sensing, and plant monitoring.
Comparative ultrastructure of fibrin networks of a dog after thrombotic ischaemic stroke
Authors: Pretorius Etheresia , Windberger Ursula B. , Oberholzer Hester M. , Auer Roland E.
Published: November 2010

A cerebrovascular accident or stroke is a rare condition in dogs, but previous studies suggest that it is now increasingly being recognised. Platelets and fibrin networks are involved in haemostasis,which is disrupted during a thrombotic event. In this study we investigate the ultrastructure of the fibrin networks of a dog that had suffered ischaemic stroke, following suspected thromboembolism from clots that became dislodged during catheter maintenance (flushing with heparinised saline) 2 days after carotid artery catheter insertion. Fibrin networks of blood samples that were collected immediately after the stroke, 15 min after treatment with streptokinase and 24 h after treatment, were studied. The results were compared to those of two control dogs. During a stroke, fibrin morphology changes to form a thick, matted layer.Post-treatment ultrastructure shows that the fibrin morphology returns to that comparable to controls. Our results show that during thrombotic risk, fibrin network morphology changes visibly and reduces the fibrinolytic activity of the coagulation system.
Lisdexamfetamine: Stimulant Prodrug for ADHD in Children and Adults
Authors: Chauhan Mohit , Bestha Durga Prasad , Madaan Vishal
Published: November 2010

Lisdexamfetamine (LDX) is the only available stimulant prodrug formulation that has been approved by the Food and Drug Administration (FDA) for treatment of ADHD in children and adults. It is enzymatically hydrolyzed to the active d-amphetamine and essential amino acid L-lysine. This rate limited enzyme mediated step underlies the consistent, predictable levels throughout the day and limits its potential for misuse. It is effective, safe and well tolerated and has an adverse effect profile comparable to other extended release stimulant formulations. The d-amphetamine levels from LDX are more consistent than that from extended release mixed amphetamine salts. LDX has shown efficacy for ADHD in clinical trials involving children and adults. Ongoing research studies are attempting to establish its long term efficacy and tolerability in patients with ADHD and also its use for some novel applications in patients with depression and other psychiatric disorders.
Pharmacotherapy of Inflammatory and Pruritic Manifestations of Corticosteroid-Responsive Dermatoses Focus on Clobetasol Propionate
Authors: Zampetti Anna , Feliciani Claudio , Tulli Antonello , Amerio Pierluigi
Published: November 2010

Clobetasol-17 propionate is a dihalogenated corticosteroid which, on the basis of the vasoconstrictor assay, is classified as the most potent of all topical steroids. Since 1973 it has been marketed specifically for the short term topical treatment of moderate and severe cortico-responsive dermatoses for its antinflammatory, immunosuppressive and antimitotic effects. Psoriasis, atopic dermatitis, chronic eczema, boullous disorders and itching dermatosis of the genital area are usually well controlled by clobetasol with a great improvement of quality of life in patients.

In this manuscript, we reviewed data concerning pharmacology, efficacy and safety profile of clobetasol-17 proprionate, updated studies on its use, efficacy of different formulations and impact on quality of life in corticosteroid-responsive dermatoses.
The Role of Aldosterone Blockade in Patients with Hypertensive Heart and Cardiovascular Disease
Authors: Pitt Bertram
Published: November 2010

Aldosterone blockade has been shown to be effective in reducing total mortality in patients with severe heart failure due to systolic left ventricular dysfunction and in patients with heart failure post myocardial infarction. Increasing evidence suggests that aldosterone blockade alone and or in conjunction with an angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) with or without a thiazide diuretic may also prevent target organ damage (TOD) in patients with hypertensive heart disease (HHD) independent of its effects on blood pressure. Aldosterone blockade may be of especial value in patients with resistant hypertension, visceral obesity, and sleep apnea. Aldosterone blockade prevents myocardial fibrosis and improves echocardiographic indices of diastolic function in patients with heart failure and a normal left ventricular ejection fraction (HFNEF). Its effects on cardiovascular mortality and hospitalization for heart failure in HFNEF are currently under investigation. Aldosterone blockade has also been shown to be beneficial in preventing experimental atherosclerosis and in limiting experimental stroke, although not as yet in man. Although aldosterone may cause serious hyperkalemia this is unlikely in patients with normal renal function. Nevertheless careful selection of patients and serial monitoring of serum potassium, especially in patients with chronic kidney disease, is essential if one is to obtain benefit from this strategy. The risk/benefit of aldosterone blockade alone and or in combination with an ACE-I or ARB with or without a thiazide diuretic in patients with HHD will however require further large scale prospective randomized study.
Zonisamide as Adjunctive Therapy for Adults with Partial-Onset Epileptic Seizures: An Efficacy and Safety Review
Authors: Vossler David G.
Published: November 2010

Purpose

To provide a review of randomized controlled trials (RCTs) on the efficacy and safety of zonisamide as an adjunctive treatment for partial-onset seizures in epilepsy patients ages 12 years and above.

Methods

Medline literature search for published double-blind RCTs involving zonisamide as adjunctive treatment for simple partial, complex partial, and secondarily generalized tonic-clonic seizures.

Results

Four RCTs comprising a total of 841 patients with medically-intractable simple partial, complex partial and secondarily generalized tonic-clonic seizures were published between the years 1993 and 2005. Zonisamide doses included 0, 100, 300, 400, 500 and 600 mg/day. Median change in frequency of all partial seizures compared to baseline was a 26.9%–51.3% decrease at zonisamide doses of 400–600 mg/day compared to a 4.7% increase to 18.1% decrease with placebo. Responder rates (>50% reduction) for all partial seizures was 26.9%–52.5% for zonisamide at these doses versus 9.8%–22% reduction for placebo. A dose-response relationship was noted up to 500 mg/day. Seizure free rates during the double blind treatment phases were 5%–6.2% for full-dose zonisamide versus 2% for placebo in two of the RCTs. Side effects were mostly CNS in type: somnolence, fatigue, dizziness and ataxia. Mild weight loss and anorexia were reported. Symptomatic renal calculi and serious rashes were not reported, but a few cases of possible stones seen transiently on ultrasound occurred, in these 4 RCTs. Four deaths occurred: none were taking zonisamide, and two appeared to be related to suffocation during seizures. Suicidal ideation and behavior occurred equally in placebo- and ZNS-treated subjects. Post-approval information suggests the rare occurrences of metabolic acidosis, oligohydrosis and hyperthermia, more commonly in children.

Conclusion

Zonisamide at a daily dose up to 600 mg is effective and generally well tolerated as adjunctive therapy in adolescents and adults with refractory partial-onset seizures.
Infliximab: A Review of its use in the Treatment of Pediatric Crohn's Disease
Authors: Broder Arkady , Rosh Joel R.
Published: November 2010

The past decade has brought great change to the treatment of pediatric Crohn's disease. The majority of affected patients now receive therapy directed at the underlying immune dysregulation that is associated with this chronic disease. The monoclonal antibodies directed against tumor necrosis factor alpha play an increasing role in such therapy. Infliximab is the prototype of this class of biologic based therapy. This review covers the basic pharmacokinetics of infliximab while reviewing the data on its efficacy in pediatric Crohn's disease patients. Current issues related to infliximab dosing and safety are also reviewed.
Targeting the Ubiquitin-proteasome System for the Treatment of Multiple Myeloma and Other Human Diseases
Authors: Podar Klaus , Anderson Kenneth C.
Published: November 2010

The ubiquitin-proteasome-degradation system plays a key role in multiple cellular functions. Its deregulation is associated with the initiation and progression of human diseases including not only solid and hematologic malignancies but also neurologic and autoimmune disorders. This article discusses several novel mechanistic aspects of the ubiquitin-proteasome system. Moreover, it focuses on the development, mechanisms of action, and clinical experience with Bortezomib, the first in-class-proteasome inhibitor to enter the clinics. Finally, it summarizes novel approaches to specifically target distinct components within the highly complex and dynamic ubiquitin-proteasome machinery to ultimately further increase drug activity, as well as reduce drug resistance and adverse side effects.
Role of Metabolic Modulation in the Management of Chronic Ischemic Heart Disease
Authors: Salerno Anna , Fragasso Gabriele , Montanaro Claudia , Cera Michela , Torlasco Camilla , Maranta Francesco , Margonato Alberto
Published: November 2010

Coronary artery disease (CAD) is a major cause of morbidity and mortality in the world. Therapy for stable CAD is currently based on conventional medical therapy, including nitrates, β-blockers and calcium-channels antagonists and, more recently, metabolic therapy, of which a pivotal therapeutic role is increasingly recognized. Under normoxic condition, the healthy heart derives 2/3 of its energy from the free fatty acid (FFA) pathway, the other source of energy being derived from glucose oxidation. However, glycolysis requires less O2 per mole of ATP generated compared with FFA oxidation. On this basis, shifting energy substrate utilization from fatty acid metabolism to glucose metabolism can be more efficient in terms of ATP production per mole of oxygen utilized. A number of different approaches have been used to manipulate energy metabolism in the heart. These approaches include direct agents, such as dichloroacetate, L-carnitine, ribose or lipoic acid which directly increase glucose oxidation, or indirect methods, through the inhibition of free fatty acids oxidation. Among these, the most important are carnitil-palmitoyl-transpherase I (CPT-I) inhibitors, which inhibit FFA mitochondrial uptake (e.g. etomoxir, perhexiline, oxphenicine), or 3-ketoacyl-coenzyme-A thiolase (3-KAT) inhibitors, such as trimetazidine, which inhibits the last enzyme involved in β-oxidation. In most patients with ischemic heart disease metabolic abnormalities, if not adequately treated, will heavily contribute to the occurrence of complications, of whom severe left ventricular dysfunction is at present one of the most frequent and insidious. In this paper, all possible metabolic approaches to ischemic heart disease are reviewed and discussed.
A Review of Exenatide in the Treatment of Type 2 Diabetes Mellitus
Authors: Samat Aashish G. , Bhargava Amit , Reddy Vasantha
Published: November 2010

Diabetes Mellitus (DM) is a chronic disease, with a rapidly increasing worldwide incidence and prevalence. Diabetes accounts for 8% of the US population, according to the United States Centers for Disease Control and Prevention. In terms of individuals, this number comes to a staggering 24 million. 1 In 2007, the total direct medical cost of treating diabetes and its associated complications was $116 billion. More than half of this is spent in treating its complications, both micro and macrovasular. Indirect costs in terms of disability, loss of work or premature mortality amounted to an additional $58 billion. 2 Several trials have shown the benefits of improved glycemic control on microvasular complications 3 – 7 and a propensity to reduce macrovasular disease. Furthermore tight glycemic control early in the disease, so called the legacy effect, has shown to reduce mortality. 5 However, these and several other trials have shown the progressive and unrelenting nature of the disease. Reduced efficacies of existing medications over prolonged periods, and continued beta cell dysfunction have lead to unmet glycemic targets. In addition, current antidiabetic medications have significant side effects most of which include hypoglycemia and weight gain. All the above points are rasion d'être that new additional therapies are needed. Recently, new classes of agents targeting the incretin system have become available. These can be divided into two broad categories; glucagon like peptide-1 (GLP-1) agonists/analogs (exenatide, liraglutide), and dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, vildagliptin, and Saxagliptin (undergoing phase 3 trials)). Exenatide, a 39-amino acid peptide produced in the salivary gland of the Gila monster lizard, is a GLP-1 agonist. It is the first of its class approved for use as adjunctive therapy, in patients with Type 2 diabetes mellitus (T2DM). Current data suggests that exenatide, in combination with metformin, glyburide, or a glitazone, results in significant reductions in fasting and postprandial plasma glucose and hemoglobin A1c (HbA1c). Apart form gastrointestinal side effects, exenatide is relatively well tolerated and does not cause hypoglycemia when used alone. Additionally, the drug serves to promote moderate weight loss. The authors aim to provide a comprehensive overview of exenatide, detail its mechanism of action, and discuss its role in the present day treatment of patients with T2DM.
Palonosetron Hydrochloride in the Prevention and Treatment of Postoperative Nausea and Vomiting
Authors: Wallenborn Jan , Kranke Peter
Published: November 2010

On the strength of two phase III clinical trials, palonosetron hydrochloride was granted FDA approval in March 2008 for the prevention of postoperative nausea and vomiting (PONV) in the period up to 24 hours after surgery. Palonosetron is superior to the established first-generation 5-hydroxytryptamin-3 receptor antagonists (5-HT3-RAs) in respect of pharmacokinetic data such as a high receptor binding affinity (pKi = 10.45) and a prolonged mean elimination half-life (40 hours). Clinically, palonosetron 0.075 mg was superior to placebo within the 0 to 24 h period usually investigated. A pooled data analysis of the complete response (CR) rates revealed efficacy in the 0 to 24 h period (when compared to placebo CR = 1.67 [1.38–2.02; P < 0.001, n = 370]) and between 24–72 h after surgery (CR = 1.29 [1.10–1.51; P = 0.002, n = 273]). Overall, the effect of palonosetron in reducing delayed vomiting was not as promising as expected. In the approval studies for PONV the rates of AEs including headache (3%), constipation (2%) and prolongation of the QTc interval (5%) were indistinguishable between palonosetron and placebo. In studies on chemotherapy-induced nausea and vomiting, palonosetron increased the QTc interval (between one and three ms) to a lesser extent than ondansetron or dolasetron (5 ms). The safety profile of palonosetron therefore seems to be favourable so far, making it a preferred perioperative antiemetic in the geriatric population or in multimorbid patients. However, further studies are needed to permit general recommendations, and we still lack comparative trials with older (and less expensive) 5-HT3-RAs, trials with combined PONV prophylaxis, and trials in the paediatric population.
Recent Updates in Both the Diagnosis and Treatment Options that Impact the Clinical Treatment of Pulmonary Arterial Hypertension
Authors: Burger Charles D.
Published: November 2010

The evaluation and management of pulmonary arterial hypertension (PAH) is a rapidly evolving area of subspecialty medicine requiring regular clinical updates. Most notably are changes in the World Health Organization diagnostic scheme whereby the clinician categorizes the correct type of pulmonary hypertension in order direct the most specific evaluation and treatment plan. In addition, there have been several changes in both the FDA-approved pharmaceutical formulations and new agents for the treatment of PAH. This review will provide an update in these areas and more importantly, guidance to the clinician on the most appropriate utilization of these new treatment options.
Pegylated Liposomal Doxorubicin in the Management of Ovarian Cancer
Authors: Ferrandina Gabriella , Petrillo Marco , Licameli Angelo , Fuoco Gilda , Scambia Giovanni , Corrado Giacomo
Published: November 2010

Despite the cytoreductive efforts, and the high responsiveness to standard carboplatin/pacllitaxel front-line treatment, ovarian cancer (OvCa) remains the most lethal gynaecological malignancy with a 5-yr overall survival of only 25%–30% in advanced stage disease. Among the pharmaceutical options available for treatment of OvCa, much attention has been dedicated to pegylated liposomal doxorubicin (PLD) (Doxil® in the US; Caelyx® in Canada and Europe); this drug has a unique formulation which has entrapped conventional doxorubicin in a bilayer lipidic sphere surrounded by a polyethylene glycol layer, which prolongs the persistence of the drug in the circulation and potentiates its intratumor accumulation. These properties represent the winning resource for this drug in that sustain its very favourable toxicity profile and the safe combination with other drugs.

PLD has already been approved for treatment of advanced ovarian cancer patients failing first line platinum-based treatment. Moreover, Phase III trials have been completed, which will hopefully will bring PLD to front-line treatment, and in salvage setting in combination with platinum agents.

This concise review will focus on the clinical role of PLD in the management of patients with epithelial OvCa.
Pharmacotherapy Update: Vinorelbine in the Treatment of non-small-cell Lung cancer
Authors: Trédaniel Jean , Staudacher Lionel , Teixeira Luis , Sebbagh Sihem , Bucquet Sébastien , Hennequin Christophe
Published: November 2010

Non-small cell lung cancer (NSCLC) is the most deadly cancer in the world. Vinorelbine is an active vinca-alkaloid with a broad spectrum of anti-tumour activity. In particular, it has high activity in NSCLC, where a synergy with cisplatin has been demonstrated. Recently, oral vinorelbine has shown a similar activity and efficacy as compared to the intravenous formulation, giving to the patient an easier way of administration and increasing his comfort. Although surgery remains the best chance of cure for patients with resectable NSCLC, it is now accepted that postoperative cisplatin-based adjuvant chemotherapy significantly improves survival in patients with NSCLC. The combination of cisplatin and vinorelbine is the most active among all the adopted schedules. Patients presenting with locally advanced disease at diagnosis benefit from concomitant chemotherapy with cisplatin-vinorelbine regimen in combination with thoracic radiotherapy. Platinum-based combinations have become the standard of care for treating NSCLC. Vinorelbine–cisplatin combination is one of the proposed doublets for treating advanced, metastatic, NSCLC. Because of its favorable toxicity profile, vinorelbine has become a major compound as a treatment for elderly patients with advanced NSCLC.
Effectiveness and Safety of Rizatriptan Benzoate 10 mg in the Treatment of Migraine Headaches
Authors: Aubé Michel , Chouha Fridon , Vaillancourt Julie , Sampalis John
Published: November 2010

Background

Patients that do not achieve therapeutic response with over the counter non-triptan medications may benefit from triptan-based treatments.

Objective

Phase I V, open-label, multi-center, prospective cohort study assessing the effectiveness of rizatriptan in the management of migraines for patients that have not responded to non-triptan treatment.

Methods

Patients were treated with one rizatriptan (MAXALT RPD®) 10 mg wafer at the onset of each migraine attack and were assessed after a minimum of one and a maximum of two consecutive headache episodes. Outcome measures included self-reported assessments (severity and duration of migraine headache) and the Migraine ACT questionnaire.

Results

A total of 369 patients were enrolled, of which 291 and 215 reported one and two attacks, respectively. For the first and second attacks, 47.2% and 53.9% of patients reported complete resolution of pain while 73.6% and 77.0% reported pain severity reduction within two hours of onset. Mean (SD) pain severity score (four-point Likert scale) during the 488 migraine episodes was reduced significantly ( P < 0.001) from 2.56 (0.49) at onset to 1.91 (0.85) at 30, 1.31 (1.00) at 60 and 0.84 (1.00) at 120 minutes. Similar improvements were observed for changes in Migraine ACT questionnaire scores. No treatment-related serious adverse events were reported. The most frequently reported non-serious adverse events that were attributed to the study drug were dizziness (2.2%), chest discomfort (1.1%), nausea (1.1%), and somnolence (0.8%).

Conclusion

In a real-life setting, rizatriptan benzoate 10 mg is effective and safe in the treatment of acute migraine headaches in patients who do not respond to non-triptan treatment.
Intranasal Mometasone Furoate for Treatment of Allergic Rhinitis
Authors: Berlucchi Marco , Pedruzzi Barbara
Published: November 2010

Allergic rhinitis (AR) is a chronic nasal disease that affects the upper respiratory tract. This disorder is characterized by inflammation of the mucous membranes and it manifests with several nasal symptoms accompanied sometimes by non-nasal symptoms. Best therapy aims to prevent and improve the AR-clinical picture. Steroids have an important role in the treatment of AR. The development of steroids administrated directly on nasal mucosa has much reduced the systemic adverse affects associated with oral steroids therapy. Mometasone furoate aqueous nasal spray is a synthetic steroid assessed for intranasal use in the therapy of adults and children affected by AR. Such topical nasal steroid is an effective molecule improving clinical picture of AR and it is also approved as prophylactic therapy. In this article, apart from a careful description of its successful clinical use the authors review pharmacokinetic/pharmacodynamic profile, mechanism of action, safety, and efficacy of such steroid molecule.
Rituximab for Rheumatoid Arthritis: A Meta-Analysis and Systematic Review
Authors: Volkmann Elizabeth R. , Agrawal Harsh , Maranian Paul , Furst Daniel E.
Published: November 2010

Background

Rituximab (RTX) is a biological agent used for the treatment of refractory rheumatoid arthritis (RA). The present systematic review and meta-analysis update the safety and efficacy of RTX for the treatment of RA in data published since 2006.

Methods

We searched PubMed from January 2000 to March 2010, and recent ACR Annual meeting abstracts for randomized (RCT) and non-randomized, controlled clinical trials (CCT) investigating the effects of RTX in RA. Included studies were at least six months, included participants who were ≥16 years of age meeting ACR revised criteria for RA, and compared RTX in combination with any DMARD or RTX alone versus placebo or other DMARDs or any biologic. Studies were excluded if they included patients previously exposed to RTX. Two reviewers independently extracted the data, and disagreement was resolved by discussion and consensus. The primary outcome was the Disease Activity Score (DAS28). The secondary outcome was American College of Rheumatology (ACR50) response. The efficacy results were combined in a meta-analysis. The primary endpoint was analyzed as a continuous variable using a random-effects analysis model to account for the fact that intervention effects were not uniform across all the studies. The secondary endpoint was analyzed as an odds ratio using the Mantel-Haenszel estimator under a random effects model to account for heterogenity in intervention effects across the studies. Descriptive statistics were used to compare adverse event (AE) rates and included both randomized and observational trials.

Results

For the meta-analysis of efficacy, we initially examined 45 studies, devolving to 6 studies after applying inclusion/exclusion criteria. 5 were RCTs and 1 was a controlled clinical trial. Improvements in DAS28 and ACR50 statistically favored RTX ( Figure 1 ). For the safety evaluation, 22 studies (5 RCTs and 17 observational studies) were examined. Infusion-related reactions were higher in the RTX group (mean: 28%) vs. placebo (18%). Overall infection incidence was similar for both groups (RTX: 39 vs. placebo: 40%).

Conclusions

Our updated review supports RTX as a safe and efficacious therapy for treatment-naïve and methotrexate and/or TNF-alpha refractory patients with RA. AE's revealed no more frequent infections than control. Future trials need to assess the longer-term efficacy and safety of RTX for RA, as well as the optimal time of re-administration of this agent.
Global evaluation of the Collection 5 MODIS dark-target aerosol products over land
Authors: Levy R. C. , Remer L. A. , Kleidman R. G. , Mattoo S. , Ichoku C. , Kahn R. , Eck T. F.
Published: November 2010

Abstract. NASA's MODIS sensors have been observing the Earth from polar orbit, from Terra since early 2000 and from Aqua since mid 2002. We have applied a consistent retrieval and processing algorithm to both sensors to derive the Collection 5 (C005) dark-target aerosol products over land. Here, we validate the MODIS along-orbit Level 2 products by comparing to quality assured Level 2 AERONET sunphotometer measurements at over 300 sites. From 85 463 collocations, representing mutually cloud-free conditions, we find that >66% (one standard deviation) of MODIS-retrieved aerosol optical depth (AOD) values compare to AERONET-observed values within an expected error (EE) envelope of ±(0.05 + 15%), with high correlation (R = 0.9). Thus, the MODIS AOD product is validated and quantitative. However, even though we can define EEs for MODIS-reported Ångström exponent and fine AOD over land, these products do not have similar physical validity. Although validated globally, MODIS-retrieved AOD does not fall within the EE envelope everywhere. We characterize some of the residual biases that are related to specific aerosol conditions, observation geometry, and/or surface properties, and relate them to situations where particular MODIS algorithm assumptions are violated. Both Terra's and Aqua's–retrieved AOD are similarly comparable to AERONET, however, Terra's global AOD bias changes with time, overestimating (by ~0.005) before 2004, and underestimating by similar magnitude after. This suggests how small calibration uncertainties of <2% can lead to spurious conclusions about long-term aerosol trends.
Soil CO2 efflux of a larch forest in northern Japan
Authors: Liang N. , Hirano T. , Zheng Z.-M. , Tang J. , Fujinuma Y.
Published: November 2010

Abstract. We had continuously measured soil CO2 efflux (Rs) in a larch forest in northern Japan at hourly intervals for the snow-free period in 2003 with an automated chamber system and partitioned Rs into heterotrophic respiration (Rh) and autotrophic respiration (Rr) by using the trench method. In addition, we applied the soil CO2 concentration gradients method to continuously measure soil CO2 profiles under snowpack in the snowy period and to partition Rs into topsoil (Oa and A horizons) CO2 efflux (Ft) with a depth of 0.13 m and sub-soil (C horizon) CO2 efflux (Fc). We found that soil CO2 effluxes were strongly affected by the seasonal variation of soil temperature but weakly correlated with soil moisture, probably because the volumetric soil moisture (30–40% at 95% confidence interval) was within a plateau region for root and microbial activities. The soil CO2 effluxes changed seasonally in parallel with soil temperature in topsoil with the peak in late summer. On the other hand, the contribution of Rr to Rs was the largest at about 50% in early summer, when canopy photosynthesis and plant growth were more active. The temperature sensitivity (Q10) of Rr peaked in June. Under snowpack, Rs was stable until mid-March and then gradually increased with snow melting. Rs summed up to 79 gC m−2 during the snowy season for 4 months. The annual Rs was determined at 934 gC m−2 y−1 in 2003, which accounted for 63% of ecosystem respiration. The annual contributions of Rh and Rs to Rs were 57% and 43%, respectively. Based on the gradient approach, Rs was partitioned vertically into litter (Oi and Oe horizons) with a depth of 0.01–0.02 m, topsoil and sub-soil respirations with proportions of 6, 72 and 22%, respectively, on an annual basis. The vertical distribution of CO2 efflux was consistent with those of soil carbon and root biomass.
Workplace Injury and Mental Health Outcomes
Authors: Wightman Anthony , Gawaziuk Justin P. , Spiwak Rae , Burton Lauren , Comaskey Brenda , Chateau Dan , Nantais Jordan , Turgeon Thomas , Sareen Jitender , Bolton James , Kraut Allen , Logsetty Sarvesh
Published: February 2025

Importance

Workplace injury is a widespread problem that impacts mental health and quality of life and places a substantial burden on employers and the health care system.

Objective

To determine whether mental disorder rates differ following workplace injury compared with injuries outside the workplace.

Design, Setting, and Participants

This retrospective cohort study assessed individuals hospitalized for an injury requiring surgery between January 1, 2002, and December 31, 2018, with a 2-year follow-up period using population-based administrative data in Manitoba, Canada. Analyses were completed June to July 2021. This study compared 2 cohorts: individuals with a workplace injury matched 1:5 on sex, age, geographical region, and surgical procedure code with individuals with a nonworkplace injury in the general population.

Exposure

Traumatic physical injury that required surgery with anesthetic.

Main Outcomes and Measures

The outcome of interest was a diagnosis of mental disorder (anxiety, depression, substance abuse, suicide attempt, and any mental disorder), measured 2 years prior to and following injury.

Results

In this cohort study, 7556 individuals (mean [SD] age, 44.8 [13.3] years; 5721 [75.7%] male; 4624 individuals [61.2%] with urban residence; 4545 individuals [60.1%] with low income) with a workplace injury were compared with 28 901 matches from the general population. The workplace cohort had lower rates of all mental disorders (anxiety: adjusted rate ratio [ARR], 0.82; 95% CI, 0.77-0.87; depression: ARR, 0.78; 95% CI, 0.72-0.84; substance abuse: ARR, 0.63; 95% CI, 0.55-0.72; suicide attempt: ARR, 0.28; 95% CI, 0.11-0.70; and any mental disorder: ARR, 0.82; 95% CI, 0.78-0.86; all P < .0006) before their injury and for depression (ARR, 0.89; 95% CI, 0.82-0.95) and substance abuse (ARR, 0.83; 95% CI, 0.73-0.94) after their injury. The group × care period interaction term was significant for anxiety (P < .0001) and any mental disorder (P < .0001), suggesting that individuals with workplace injuries had worse mental disorder outcomes over time than individuals with nonworkplace injuries.

Conclusions and Relevance

This cohort study found that the mental health trajectory from the preinjury to postinjury period was worse for individuals with a workplace injury compared with those injured outside the workplace. These findings suggest that there may be features unique to the workplace and/or injury claims and compensation processes that contribute to this pattern, which warrant further examination.
Insights into Extrachromosomal DNA in Cancer: Biogenesis, Methodologies, Functions, and Therapeutic Potential
Authors: Mao Xudong , Rao Guocheng , Li Gonghui , Chen Shihan
Published: February 2025

Originating from, but independent of, linear chromosomes, extrachromosomal DNA (ecDNA) exists in a more active state of transcription and autonomous replication. It plays a crucial role in the development of malignancies and therapy resistance. Since its discovery in eukaryotic cells more than half a century ago, the biological characteristics and functions of ecDNA have remained unclear due to limitations in detection methods. However, recent advancements in research tools have transformed ecDNA research. It is believed that ecDNA exhibits greater activity in the abnormal amplification of oncogenes, thereby driving cancer progression through their overexpression. Notably, compared to linear DNA, ecDNA can also function as a genomic element with regulatory roles, including both trans‐ and cis‐acting functions. Its critical roles in tumorigenesis, evolution, progression, and drug resistance in malignant tumors are increasingly recognized. This review provides a comprehensive summary of the evolutionary context of ecDNA and highlights significant progress in understanding its biological functions and potential applications as a therapeutic target in malignant tumors.
Electrospinning Technology, Machine Learning, and Control Approaches: A Review
Authors: Shabani Arya , Al Gorkem Anil , Berri Nael , Castro‐Dominguez Bernardo , Leese Hannah S. , Martinez‐Hernandez Uriel
Published: February 2025

Electrospinning is a versatile technique for producing micro‐ and nanoscale fibers, offering vast potential to address critical market demands, particularly in biomedical engineering. However, the industrial adoption of electrospinning as a manufacturing technology faces significant hurdles, notably in achieving precise control over fiber properties and ensuring reproducibility and scalability. These challenges directly impact its viability for creating advanced biomedical products. Bridging the gap between material properties, end‐user requirements, and process parameters is essential for unlocking the full potential of electrospinning. This work provides a comprehensive review of electrospinning modalities, operational factors, and modeling techniques, emphasizing their role in optimizing the electrospinning process. The use of control strategies and machine learning methods is explored, showcasing their potential to enhance the electrospinning performance. This review highlights the connection between product properties and performance in electrospinning, as well as the necessary conditions for its use in biomedical applications. In addition, the review identifies gaps and unexplored areas, offering a roadmap for future innovation in fiber fabrication. By emphasizing the synergy between intelligent process design and biomedical applications, this work lays the groundwork for advancements, positioning electrospinning as a cornerstone of next‐generation manufacturing technologies.